Provider Demographics
NPI:1386992840
Name:KATAYOUN SADRI, D.D.S., P.A
Entity type:Organization
Organization Name:KATAYOUN SADRI, D.D.S., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-724-5203
Mailing Address - Street 1:2741 CAMPUS WALK AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-8878
Mailing Address - Country:US
Mailing Address - Phone:919-908-8386
Mailing Address - Fax:919-908-8386
Practice Address - Street 1:2741 CAMPUS WALK AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-8878
Practice Address - Country:US
Practice Address - Phone:919-908-8386
Practice Address - Fax:919-908-8386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty