Provider Demographics
NPI:1558484428
Name:SAGARIAN A PROFESIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:SAGARIAN A PROFESIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:MAIS
Authorized Official - Last Name:SAGARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-496-1200
Mailing Address - Street 1:505 W COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1263
Mailing Address - Country:US
Mailing Address - Phone:661-322-1300
Mailing Address - Fax:661-322-1375
Practice Address - Street 1:505 W COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1263
Practice Address - Country:US
Practice Address - Phone:661-322-1300
Practice Address - Fax:661-322-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91682Medicaid