Provider Demographics
NPI:1184023269
Name:VAHDATI, SEYED ALIAKBAR (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SEYED ALIAKBAR
Middle Name:
Last Name:VAHDATI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 PLACENTIA AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3304
Mailing Address - Country:US
Mailing Address - Phone:949-631-3380
Mailing Address - Fax:949-631-3382
Practice Address - Street 1:355 PLACENTIA AVE STE 304
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3304
Practice Address - Country:US
Practice Address - Phone:949-631-3380
Practice Address - Fax:949-631-3382
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63788122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA63788OtherCALIFORNIA STATE LICENSE