Provider Demographics
NPI:1740938554
Name:SGZ DENTAL GROUP PLLC
Entity type:Organization
Organization Name:SGZ DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:AMIR
Authorized Official - Last Name:GHASSEM-ZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-954-7543
Mailing Address - Street 1:205 RICHDALE AVE APT A11
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-3339
Mailing Address - Country:US
Mailing Address - Phone:203-954-7543
Mailing Address - Fax:
Practice Address - Street 1:92 FAUNCE CORNER RD UNIT 150
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1262
Practice Address - Country:US
Practice Address - Phone:203-954-7543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental