Healthcare Provider Details

I. General information

NPI: 1548846231
Provider Name (Legal Business Name): SABRINA REVA BAGHAIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date: 08/08/2022
Reactivation Date: 08/29/2022

III. Provider practice location address

221 SIMPSON PARK RD
SHELBY NC
28150-4299
US

IV. Provider business mailing address

1800 N BLANCHARD ST
FINDLAY OH
45840-4503
US

V. Phone/Fax

Practice location:
  • Phone: 704-484-3366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12928
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: