Provider Demographics
NPI:1982665204
Name:SANAI, REZA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:SANAI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1314
Mailing Address - Country:US
Mailing Address - Phone:773-761-2521
Mailing Address - Fax:773-761-2522
Practice Address - Street 1:1514 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1314
Practice Address - Country:US
Practice Address - Phone:773-761-2521
Practice Address - Fax:773-761-2522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics