Provider Demographics
NPI:1922508985
Name:SAMAN DELJOUI, DMD, INC.
Entity Type:Organization
Organization Name:SAMAN DELJOUI, DMD, INC.
Other - Org Name:SANTA CRUZ ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELJOUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-475-2833
Mailing Address - Street 1:1779 DOMINICAN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1526
Mailing Address - Country:US
Mailing Address - Phone:831-475-2833
Mailing Address - Fax:
Practice Address - Street 1:1779 DOMINICAN WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1526
Practice Address - Country:US
Practice Address - Phone:831-475-2833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA CRUZ ENDODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty