Basic Information
Provider Information
NPI: 1750394417
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SADRI
FirstName: AMIR
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1040 FLYNN RD
Address2:  
City: CAMARILLO
State: CA
PostalCode: 930125092
CountryCode: US
TelephoneNumber: 8056733930
FaxNumber: 8056593217
Practice Location
Address1: 4279 TIERRA REJADA RD
Address2:  
City: MOORPARK
State: CA
PostalCode: 930213775
CountryCode: US
TelephoneNumber: 8052222323
FaxNumber: 8052222333
Other Information
ProviderEnumerationDate: 08/14/2006
LastUpdateDate: 10/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X53646CAY Dental ProvidersDentist 

No ID Information.


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