MEDICARE: RANDALL SAGISI PROFESSIONAL DENTAL CORPORATION

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1780455766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL SAGISI PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	23310 CINEMA DR STE 103
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-1613
Country	:	US
Telephone Number	:	808-383-4965
Fax Number	:

Provider Business Practice Location Address
First Line	:	23310 CINEMA DR STE 103
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-1613
Country	:	US
Telephone Number	:	808-383-4965
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDALL SAGISI
Credential	:	DMD
Telephone Number	:	808-383-4965

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	01/10/2024

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