Provider Demographics
NPI:1013396423
Name:SAGISI DMD INC
Entity Type:Organization
Organization Name:SAGISI DMD INC
Other - Org Name:PRESTIGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGISI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-267-6400
Mailing Address - Street 1:38750 TRADE CENTER DR STE J
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3787
Mailing Address - Country:US
Mailing Address - Phone:661-267-6400
Mailing Address - Fax:
Practice Address - Street 1:38750 TRADE CENTER DR STE J
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3787
Practice Address - Country:US
Practice Address - Phone:661-267-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty