Provider Demographics
NPI:1659006716
Name:ALIZADEH DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALIZADEH DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-759-0238
Mailing Address - Street 1:905 SECRET RIVER DR STE F
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3437
Mailing Address - Country:US
Mailing Address - Phone:916-391-2037
Mailing Address - Fax:916-840-7972
Practice Address - Street 1:905 SECRET RIVER DR STE F
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3437
Practice Address - Country:US
Practice Address - Phone:916-391-2037
Practice Address - Fax:916-840-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental