Provider Demographics
NPI:1851801955
Name:LANGURI, MAE SEDAGHATI (DMD)
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:SEDAGHATI
Last Name:LANGURI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MAEDEH
Other - Middle Name:
Other - Last Name:SEDAGHATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:955 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1556
Mailing Address - Country:US
Mailing Address - Phone:414-236-2207
Mailing Address - Fax:
Practice Address - Street 1:694 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3882
Practice Address - Country:US
Practice Address - Phone:931-278-6793
Practice Address - Fax:414-236-2207
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist