Healthcare Provider Details

I. General information

NPI: 1073914545
Provider Name (Legal Business Name): SINAN ALHAMDI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 CARMEL COUNTRY RD STE 213
SAN DIEGO CA
92130-2172
US

IV. Provider business mailing address

9555 GOLD COAST DR APT A2
SAN DIEGO CA
92126-3933
US

V. Phone/Fax

Practice location:
  • Phone: 314-532-3941
  • Fax:
Mailing address:
  • Phone: 314-532-3914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856726
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103264
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1856726
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number103264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: