Provider Demographics
NPI:1962507467
Name:SASSANI, BARDIA ANDRE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARDIA
Middle Name:ANDRE
Last Name:SASSANI
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 1:261 CRESTVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050
Mailing Address - Country:US
Mailing Address - Phone:408-247-8400
Mailing Address - Fax:408-247-3918
Practice Address - Street 1:261 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6503
Practice Address - Country:US
Practice Address - Phone:408-247-8400
Practice Address - Fax:408-247-3918
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice