# FOULADI PROFESSIONAL DENTAL CORP.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FOULADI PROFESSIONAL DENTAL CORP.
- **Other names:** Sacramento Oral Surgery South
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669114898
- **Legal business name:** FOULADI PROFESSIONAL DENTAL CORP.
- **Authorized official:** CELIA HAYES (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-2100

## Contact information

- **Practice address:** 7551 TIMBERLAKE WAY STE 120, SACRAMENTO, CA 95823-5421
- **Practice address phone:** (916) 423-4092
- **Practice address fax:** (916) 423-3125
- **Mailing address:** 7551 TIMBERLAKE WAY STE 120, SACRAMENTO, CA 95823-5421
- **Mailing address phone:** (916) 423-4092
- **Mailing address fax:** (916) 423-3125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 04/08/2022
- **Last updated:** 04/08/2022