MEDICARE: SAEGHI PROFESSIONAL DENTAL CORP.

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	46130	CA

General Provider Information

NPI Number	:	1942331434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAEGHI PROFESSIONAL DENTAL CORP.

Provider Business Mailing Address
First Line	:	24921 PALMILLA DR
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-3053
Country	:	US
Telephone Number	:	818-712-0073
Fax Number	:	818-716-8070

Provider Business Practice Location Address
First Line	:	3151 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1805
Country	:	US
Telephone Number	:	818-712-0073
Fax Number	:	818-716-8070

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALI SAEGHI
Credential	:	D.D.S.
Telephone Number	:	818-712-0073

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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