=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447505482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN H. SASADA DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2012
-----------------------------------------------------
Last Update Date | 07/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 248 W HARVARD BLVD SUITE B
-----------------------------------------------------
City | SANTA PAULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93060-3948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-525-1573
-----------------------------------------------------
Fax | 805-525-2676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 248 W HARVARD BLVD SUITE B
-----------------------------------------------------
City | SANTA PAULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93060-3948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-525-1573
-----------------------------------------------------
Fax | 805-525-2676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | BRIAN H. SASADA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 805-525-1573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 28484
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------