Provider Demographics
NPI:1588082838
Name:SAGHIZADEH, SAMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMAN
Middle Name:
Last Name:SAGHIZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 AVENIDA ORIENTE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4332
Mailing Address - Country:US
Mailing Address - Phone:310-666-7316
Mailing Address - Fax:
Practice Address - Street 1:9145 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3031
Practice Address - Country:US
Practice Address - Phone:818-886-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist