Provider Demographics
NPI:1487287843
Name:SAEIDI DDS INC
Entity type:Organization
Organization Name:SAEIDI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD-REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-545-0944
Mailing Address - Street 1:1820 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6616
Mailing Address - Country:US
Mailing Address - Phone:707-545-0944
Mailing Address - Fax:
Practice Address - Street 1:1820 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6616
Practice Address - Country:US
Practice Address - Phone:707-545-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty