Provider Demographics
NPI:1073195756
Name:SEMSAR, DORSA
Entity Type:Individual
Prefix:
First Name:DORSA
Middle Name:
Last Name:SEMSAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7451 EDINGER AVE 400
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:301-956-9470
Mailing Address - Fax:
Practice Address - Street 1:6437 E PACIFIC COAST HWY UNIT A-6
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-0001
Practice Address - Country:US
Practice Address - Phone:562-280-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133241223G0001X
CA1084361223G0001X
CT131101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice