Provider Demographics
NPI:1477711372
Name:RASTEGAR PANAH, SORMEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SORMEH
Middle Name:
Last Name:RASTEGAR PANAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SORMEH
Other - Middle Name:
Other - Last Name:ASKARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1926 VOORHEES AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278
Mailing Address - Country:US
Mailing Address - Phone:310-709-8675
Mailing Address - Fax:
Practice Address - Street 1:2731 MANHATTAN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278
Practice Address - Country:US
Practice Address - Phone:310-643-0880
Practice Address - Fax:310-643-0801
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist