MEDICARE: MARIAM ALSAADI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	111820	CA

General Provider Information

NPI Number	:	1558051524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM ALSAADI DMD

Provider Business Mailing Address
First Line	:	28080 CLINTON KEITH RD STE 100
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-4553
Country	:	US
Telephone Number	:	951-370-1529
Fax Number	:

Provider Business Practice Location Address
First Line	:	28080 CLINTON KEITH RD STE 100
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-4553
Country	:	US
Telephone Number	:	951-370-1529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	04/01/2026

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