Provider Demographics
NPI:1043896103
Name:YADEGARAN, DALIT (DMD)
Entity Type:Individual
Prefix:
First Name:DALIT
Middle Name:
Last Name:YADEGARAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-3040
Mailing Address - Country:US
Mailing Address - Phone:310-490-4381
Mailing Address - Fax:
Practice Address - Street 1:6101 W CENTINELA AVE STE 375
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6389
Practice Address - Country:US
Practice Address - Phone:310-929-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1057261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice