Provider Demographics
NPI:1114005030
Name:SADEGHEIN, AHMADG (DDS)
Entity Type:Individual
Prefix:DR
First Name:AHMADG
Middle Name:
Last Name:SADEGHEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N CENTRAL AVE
Mailing Address - Street 2:750
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3905
Mailing Address - Country:US
Mailing Address - Phone:818-551-5055
Mailing Address - Fax:818-246-2463
Practice Address - Street 1:500 N CENTRAL AVE
Practice Address - Street 2:750
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3905
Practice Address - Country:US
Practice Address - Phone:818-551-5055
Practice Address - Fax:818-246-2463
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics