Provider Demographics
NPI:1942605662
Name:AGHABEIGI, SASAN (DDS)
Entity Type:Individual
Prefix:
First Name:SASAN
Middle Name:
Last Name:AGHABEIGI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9381 E STOCKTON BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5069
Mailing Address - Country:US
Mailing Address - Phone:916-683-2000
Mailing Address - Fax:916-683-2003
Practice Address - Street 1:9381 E STOCKTON BLVD STE 116
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5069
Practice Address - Country:US
Practice Address - Phone:916-683-2000
Practice Address - Fax:916-683-2003
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist