Provider Demographics
NPI:1629294319
Name:SADRINIA, MOHAMMAD JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:JAY
Last Name:SADRINIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1400
Mailing Address - Country:US
Mailing Address - Phone:859-331-8200
Mailing Address - Fax:859-331-0456
Practice Address - Street 1:2446 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1400
Practice Address - Country:US
Practice Address - Phone:859-344-9222
Practice Address - Fax:859-344-1490
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60065968Medicaid