Provider Demographics
NPI:1932579786
Name:CUPERTINO COSMETIC & FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CUPERTINO COSMETIC & FAMILY DENTISTRY
Other - Org Name:DR. KHALIL SAGHEZCHI
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAGHEZCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-865-1777
Mailing Address - Street 1:10413 TORRE AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3239
Mailing Address - Country:US
Mailing Address - Phone:408-865-1777
Mailing Address - Fax:408-865-1779
Practice Address - Street 1:10413 TORRE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3239
Practice Address - Country:US
Practice Address - Phone:408-865-1777
Practice Address - Fax:408-865-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty