Provider Demographics
NPI:1508579285
Name:SODEIFI, DMD, MD, INC.
Entity Type:Organization
Organization Name:SODEIFI, DMD, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SODEIFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-838-8702
Mailing Address - Street 1:PO BOX 20307
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95160-0307
Mailing Address - Country:US
Mailing Address - Phone:408-838-8702
Mailing Address - Fax:
Practice Address - Street 1:18805 COX AVE STE 130
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6614
Practice Address - Country:US
Practice Address - Phone:408-222-3354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Single Specialty