Provider Demographics
NPI:1154451565
Name:SADRAMELI, MAHTAB (DMD, MAGD)
Entity Type:Individual
Prefix:DR
First Name:MAHTAB
Middle Name:
Last Name:SADRAMELI
Suffix:
Gender:F
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 CALIFORNIA ST APT 411
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4306
Mailing Address - Country:US
Mailing Address - Phone:415-775-7918
Mailing Address - Fax:
Practice Address - Street 1:2095 CALIFORNIA ST APT 411
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4306
Practice Address - Country:US
Practice Address - Phone:415-775-7918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist