Provider Demographics
NPI:1568099430
Name:M SADRAMELI DMD LLC
Entity Type:Organization
Organization Name:M SADRAMELI DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHTAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SADRAMELI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-336-0767
Mailing Address - Street 1:1201 S PRAIRIE AVE APT 4805
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3570
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 REFLECTION DR STE 112
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9701
Practice Address - Country:US
Practice Address - Phone:639-718-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M SADRAMELI DMD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty