Provider Demographics
NPI:1093178055
Name:SONNY AFSHAR DDS INC
Entity Type:Organization
Organization Name:SONNY AFSHAR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:AFSHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-773-6222
Mailing Address - Street 1:2030 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 37
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3855
Mailing Address - Country:US
Mailing Address - Phone:916-773-6222
Mailing Address - Fax:916-773-5666
Practice Address - Street 1:2030 DOUGLAS BLVD
Practice Address - Street 2:SUITE 37
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3855
Practice Address - Country:US
Practice Address - Phone:916-773-6222
Practice Address - Fax:916-773-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty