Provider Demographics
NPI:1760788392
Name:AMIN SADEGHI DMD INC
Entity Type:Organization
Organization Name:AMIN SADEGHI DMD INC
Other - Org Name:DENTAL SPA ON FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMINOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-229-6249
Mailing Address - Street 1:4747 N 1ST ST STE 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0517
Mailing Address - Country:US
Mailing Address - Phone:559-229-6249
Mailing Address - Fax:559-229-0342
Practice Address - Street 1:4747 N 1ST ST STE 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0517
Practice Address - Country:US
Practice Address - Phone:559-229-6249
Practice Address - Fax:559-229-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50519261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental