Provider Demographics
NPI:1386210540
Name:EDALATPOUR, SAHAR (DDS)
Entity Type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:EDALATPOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 WASHINGTON AVE N APT 531
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2746
Mailing Address - Country:US
Mailing Address - Phone:414-467-9512
Mailing Address - Fax:
Practice Address - Street 1:1670 BEAM AVE STE 204
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1227
Practice Address - Country:US
Practice Address - Phone:651-925-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MND14625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program