Provider Demographics
NPI:1225191067
Name:SADEGHI, EZEDIN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:EZEDIN
Middle Name:M
Last Name:SADEGHI
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 1:8760 N SENECA RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2332
Mailing Address - Country:US
Mailing Address - Phone:414-352-3969
Mailing Address - Fax:
Practice Address - Street 1:8760 N SENECA RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-2332
Practice Address - Country:US
Practice Address - Phone:414-352-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29941223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology