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General NPI Number Information
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NPI Number | 1508579285
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Entity Type | Organization
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Legal Business Name | SODEIFI, DMD, MD, INC.
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 18805 COX AVE STE 130
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City | SARATOGA
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State | CA
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Zip | 95070-6614
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Country | US
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Telephone | 408-222-3354
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20307
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City | SAN JOSE
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State | CA
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Zip | 95160-0307
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Country | US
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Telephone | 408-838-8702
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Fax |
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Authorized Official
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Title or Position | SURGEON
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Name | DR. ALIREZA MICHAEL SODEIFI
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Credential | MD
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Telephone | 408-838-8702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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