Provider Demographics
NPI:1942743182
Name:DEHGHAN, SARANG
Entity Type:Individual
Prefix:DR
First Name:SARANG
Middle Name:
Last Name:DEHGHAN
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 1:3245 HALVERSON WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4039
Mailing Address - Country:US
Mailing Address - Phone:213-713-2070
Mailing Address - Fax:
Practice Address - Street 1:3245 HALVERSON WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4039
Practice Address - Country:US
Practice Address - Phone:213-713-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1010361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice