NPI 1770775447 · live from the CMS NPI Registry
A Miracle Smile By Dr. Dezham Dental Group
Dentist in Sacramento, CA. National Provider Identifier 1770775447, active.
NPI record
| NPI | 1770775447 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 2131 Capitol Ave, Suite 100, Sacramento, CA 95816 |
| Practice phone | 916-441-3311 |
| Mailing address | 2131 Capitol Ave Ste 100, Sacramento, CA 95816 |
| Enumerated | August 15, 2007 |
| Last updated | August 15, 2007 |
| Authorized official | Hassan Dezham, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist primary | 122300000X | 52801 (CA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.