Provider Demographics
NPI:1447505482
Name:BRIAN H. SASADA DDS, INC.
Entity type:Organization
Organization Name:BRIAN H. SASADA DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SASADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-525-1573
Mailing Address - Street 1:248 W HARVARD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3948
Mailing Address - Country:US
Mailing Address - Phone:805-525-1573
Mailing Address - Fax:805-525-2676
Practice Address - Street 1:248 W HARVARD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3948
Practice Address - Country:US
Practice Address - Phone:805-525-1573
Practice Address - Fax:805-525-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28484261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental