Provider Demographics
NPI:1396876397
Name:SAGARIAN, MIKE MAIS (DDS)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:MAIS
Last Name:SAGARIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MAIS
Other - Middle Name:
Other - Last Name:SAGHARIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1229 7-TH ST.
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280
Mailing Address - Country:US
Mailing Address - Phone:661-758-5338
Mailing Address - Fax:661-758-8150
Practice Address - Street 1:1229 7-TH ST.
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280
Practice Address - Country:US
Practice Address - Phone:661-758-5338
Practice Address - Fax:661-758-8150
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436551223G0001X
NV4728T1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9168202OtherDENTICAL PROVIDER NUMBER