Provider Demographics
NPI:1740349877
Name:SABBAGHZADEH, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SABBAGHZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16101 VENTURA BLVD STE 329
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2516
Mailing Address - Country:US
Mailing Address - Phone:310-746-8599
Mailing Address - Fax:
Practice Address - Street 1:16101 VENTURA BLVD STE 329
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2516
Practice Address - Country:US
Practice Address - Phone:310-746-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice