Provider Demographics
NPI:1780455766
Name:RANDALL SAGISI PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:RANDALL SAGISI PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGISI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-383-4965
Mailing Address - Street 1:23310 CINEMA DR STE 103
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1613
Mailing Address - Country:US
Mailing Address - Phone:808-383-4965
Mailing Address - Fax:
Practice Address - Street 1:23310 CINEMA DR STE 103
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1613
Practice Address - Country:US
Practice Address - Phone:808-383-4965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty