Individual provider Active NPI

Saba Noori Sadeghi, D.D.S

  • Dentist
  • Glendale, AZ
National Provider Identifier
1457743452
Registry record updated Apr 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D009421 Issued in AZ
Practice address
5143 W Olive Ave
Suite 140
Glendale, AZ 85302-4206
Phone
(414) 736-8316
NPI assigned
Feb 27, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D009421 AZ Primary

Addresses

Primary practice location

5143 W Olive Ave
Suite 140
Glendale, AZ 85302-4206

Mailing address

5143 W Olive Ave
Suite 140
Glendale, AZ 85302-4206
Phone (414) 736-8316

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160923001340 AZ Order and Referring Only - DentistPractitioner - Dentist 0143517862

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D009421AZMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461283200000",
    "number": "1457743452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5143 W OLIVE AVE",
            "address_2": "SUITE 140",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853024206",
            "telephone_number": "414-736-8316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5143 W OLIVE AVE",
            "address_2": "SUITE 140",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853024206",
            "telephone_number": "414-736-8316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADEGHI",
        "first_name": "SABA",
        "middle_name": "NOORI",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-27",
        "last_updated": "2016-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D009421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.