Provider Demographics
NPI:1265679559
Name:SAGHEZCHI, KHALIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:
Last Name:SAGHEZCHI
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 1:2725 EL CAMINO REAL STE 109
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3000
Mailing Address - Country:US
Mailing Address - Phone:408-241-4111
Mailing Address - Fax:408-241-5940
Practice Address - Street 1:2725 EL CAMINO REAL STE 109
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-3000
Practice Address - Country:US
Practice Address - Phone:408-241-4111
Practice Address - Fax:408-241-5940
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice