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General NPI Number Information
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NPI Number | 1740544303
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Entity Type | Individual
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Provider Name | ALIREZA SADRE-NASSIRI D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 925 BEVINS CT
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City | LAKEPORT
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State | CA
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Zip | 95453-9754
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Country | US
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Telephone | 707-263-8382
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Fax | 707-263-5326
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Provider Business Mailing Address
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Address Line | PO BOX 1950
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City | LAKEPORT
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State | CA
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Zip | 95453-1950
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Country | US
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Telephone | 707-263-8382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 056780
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60737991
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 056780
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 109541
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License Number State | CA
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