Provider Demographics
NPI:1700651890
Name:SANAZ ABADI DMD
Entity Type:Organization
Organization Name:SANAZ ABADI DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANAZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABADI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-490-8822
Mailing Address - Street 1:26 FOXGLOVE WAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2712
Mailing Address - Country:US
Mailing Address - Phone:949-490-8822
Mailing Address - Fax:
Practice Address - Street 1:24602 RAYMOND WAY STE 211
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8420
Practice Address - Country:US
Practice Address - Phone:949-461-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental