Provider Demographics
NPI:1861002933
Name:SEYED SADRKHANI, SEYED MOEIN
Entity Type:Individual
Prefix:
First Name:SEYED MOEIN
Middle Name:
Last Name:SEYED SADRKHANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 PRESTON RD APT 430
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-3231
Mailing Address - Country:US
Mailing Address - Phone:310-902-0528
Mailing Address - Fax:
Practice Address - Street 1:8335 WALNUT HILL LN STE 125
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4222
Practice Address - Country:US
Practice Address - Phone:214-691-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty