Provider Demographics
NPI:1548612708
Name:SEDDIGHZADEH, BRAD DARIUSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:DARIUSH
Last Name:SEDDIGHZADEH
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 1:1583 COMMON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3174
Mailing Address - Country:US
Mailing Address - Phone:830-660-1669
Mailing Address - Fax:
Practice Address - Street 1:1583 COMMON ST STE 205
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3174
Practice Address - Country:US
Practice Address - Phone:830-660-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice