Provider Demographics
NPI:1912109752
Name:SAEIAN, KAMYAR (DDS)
Entity Type:Individual
Prefix:
First Name:KAMYAR
Middle Name:
Last Name:SAEIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3780 LITTLE PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-1749
Mailing Address - Country:US
Mailing Address - Phone:262-642-5119
Mailing Address - Fax:
Practice Address - Street 1:3970 N OAKLAND AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-967-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist