Provider Demographics
NPI:1720559339
Name:SAYEH MASSOUMI,DENTAL CORPORATION
Entity Type:Organization
Organization Name:SAYEH MASSOUMI,DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAYEH
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:MASSOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-623-9282
Mailing Address - Street 1:11113 ROCKRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 CALLOWAY DR STE 200B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6391
Practice Address - Country:US
Practice Address - Phone:714-623-9282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972795953Medicaid