Provider Demographics
NPI:1639401292
Name:ALSADI, SALLY MOHAMMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:MOHAMMED
Last Name:ALSADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 W STOCKTON BLVD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8014
Mailing Address - Country:US
Mailing Address - Phone:916-684-8373
Mailing Address - Fax:
Practice Address - Street 1:9340 W STOCKTON BLVD
Practice Address - Street 2:SUITE #120
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8014
Practice Address - Country:US
Practice Address - Phone:916-684-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD53400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist