Healthcare Provider Details

I. General information

NPI: 1306022660
Provider Name (Legal Business Name): IMAD BEDDAWI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 FLORIN RD #18
SACRAMENTO CA
95822
US

IV. Provider business mailing address

1355 FLORIN RD #18
SACRAMENTO CA
95822
US

V. Phone/Fax

Practice location:
  • Phone: 916-391-1161
  • Fax: 916-391-1164
Mailing address:
  • Phone: 916-391-1161
  • Fax: 916-391-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number40536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: