=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538005434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHSA SADRI DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2026
-----------------------------------------------------
Last Update Date | 04/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1844 E 9400 S
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84093-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-386-8793
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 152 E MIDVILLAGE BLVD APT 108
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84070-1374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-961-4976
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 14282347-9926
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------