Provider Demographics
NPI:1962561340
Name:FOULADI, REZA (DDS, MD)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:FOULADI
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7551 TIMBERLAKE WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5421
Mailing Address - Country:US
Mailing Address - Phone:949-727-7000
Mailing Address - Fax:949-727-3924
Practice Address - Street 1:7551 TIMBERLAKE WAY STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5421
Practice Address - Country:US
Practice Address - Phone:949-727-7000
Practice Address - Fax:949-727-3924
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126291204E00000X
CA551721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery