Provider Demographics
NPI:1639407216
Name:SAREMI, AMID EDDIE
Entity Type:Individual
Prefix:DR
First Name:AMID
Middle Name:EDDIE
Last Name:SAREMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 E THOUSAND OAKS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2954
Mailing Address - Country:US
Mailing Address - Phone:805-496-7776
Mailing Address - Fax:805-496-8587
Practice Address - Street 1:1868 E THOUSAND OAKS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2954
Practice Address - Country:US
Practice Address - Phone:805-496-7776
Practice Address - Fax:805-496-8587
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice