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General NPI Number Information
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NPI Number | 1679023048
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Entity Type | Organization
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Legal Business Name | SAM SAADAT DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 3327 KIMBER DR SUITE D
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City | NEWBURY PARK
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State | CA
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Zip | 91320-4315
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Country | US
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Telephone | 805-499-3691
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Fax | 805-499-4652
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Provider Business Mailing Address
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Address Line | 3327 KIMBER DR SUITE D
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City | NEWBURY PARK
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State | CA
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Zip | 91320-4315
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Country | US
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Telephone | 805-499-3691
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Fax | 805-499-4652
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SAM SAADAT
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Credential |
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Telephone | 805-499-3691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 59390
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 55438
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 58415
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License Number State | CA
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