Provider Demographics
NPI:1376932137
Name:MORVARID SADRI DDS PC
Entity Type:Organization
Organization Name:MORVARID SADRI DDS PC
Other - Org Name:SADRI'S FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORVARID
Authorized Official - Middle Name:
Authorized Official - Last Name:SADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-404-8030
Mailing Address - Street 1:3834 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2766
Mailing Address - Country:US
Mailing Address - Phone:773-404-8030
Mailing Address - Fax:
Practice Address - Street 1:3834 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2766
Practice Address - Country:US
Practice Address - Phone:773-404-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty