Provider Demographics
NPI:1215946447
Name:SAJJADI A DENTAL CORPORATION
Entity type:Organization
Organization Name:SAJJADI A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIRSAEID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJJADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-675-7576
Mailing Address - Street 1:15418 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE #A
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3828
Mailing Address - Country:US
Mailing Address - Phone:310-675-7576
Mailing Address - Fax:310-675-7779
Practice Address - Street 1:15418 HAWTHORNE BLVD
Practice Address - Street 2:SUITE #A
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3828
Practice Address - Country:US
Practice Address - Phone:310-675-7576
Practice Address - Fax:310-675-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92446-01OtherMEDICAL