Healthcare Provider Details

I. General information

NPI: 1508579285
Provider Name (Legal Business Name): SODEIFI, DMD, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18805 COX AVE STE 130
SARATOGA CA
95070-6614
US

IV. Provider business mailing address

PO BOX 20307
SAN JOSE CA
95160-0307
US

V. Phone/Fax

Practice location:
  • Phone: 408-222-3354
  • Fax:
Mailing address:
  • Phone: 408-838-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALIREZA MICHAEL SODEIFI
Title or Position: SURGEON
Credential: MD
Phone: 408-838-8702