Provider Demographics
NPI:1518093111
Name:SHAHRYAR SEFIDPOUR,DDS MSD INC
Entity Type:Organization
Organization Name:SHAHRYAR SEFIDPOUR,DDS MSD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SEFIDPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD
Authorized Official - Phone:916-774-6986
Mailing Address - Street 1:4150 DOUGLAS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-5908
Mailing Address - Country:US
Mailing Address - Phone:916-774-6986
Mailing Address - Fax:916-774-6533
Practice Address - Street 1:4150 DOUGLAS BLVD STE B
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-5908
Practice Address - Country:US
Practice Address - Phone:916-774-6986
Practice Address - Fax:916-774-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA984421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty