Provider Demographics
NPI:1255843025
Name:SEBTI, HOMAM (DDS)
Entity Type:Individual
Prefix:
First Name:HOMAM
Middle Name:
Last Name:SEBTI
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 1:385 CECILIA WAY APT 86
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2104
Mailing Address - Country:US
Mailing Address - Phone:510-338-8351
Mailing Address - Fax:
Practice Address - Street 1:385 CECILIA WAY APT 86
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-2104
Practice Address - Country:US
Practice Address - Phone:510-338-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist