Provider Demographics
NPI:1881656205
Name:BANKI, SEDYGHEH M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEDYGHEH
Middle Name:M
Last Name:BANKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:S.
Other - Middle Name:M
Other - Last Name:BANK,
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:141 DUESENBERG DR
Mailing Address - Street 2:STE 3
Mailing Address - City:WESTLAKE VLG
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-497-0989
Mailing Address - Fax:
Practice Address - Street 1:141 DUESENBERG DR
Practice Address - Street 2:STE 3
Practice Address - City:WESTLAKE VLG
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-497-0989
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B2614701OtherDENTICAL