Provider Demographics
NPI:1912135765
Name:SAADAT DDS, SAM (DDS)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:SAADAT DDS
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 1:3327 KIMBER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4315
Mailing Address - Country:US
Mailing Address - Phone:805-499-3691
Mailing Address - Fax:805-499-4652
Practice Address - Street 1:3327 KIMBER DR
Practice Address - Street 2:SUITE D
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4315
Practice Address - Country:US
Practice Address - Phone:805-499-3691
Practice Address - Fax:805-499-4652
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist