Provider Demographics
NPI:1134521024
Name:SEPIDEHDAM, SAHAR (DDS)
Entity type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:
Last Name:SEPIDEHDAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W. HIGH ST. #617
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93020-1820
Mailing Address - Country:US
Mailing Address - Phone:213-293-6256
Mailing Address - Fax:
Practice Address - Street 1:100 W. HIGH ST. #617
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93020-1820
Practice Address - Country:US
Practice Address - Phone:213-293-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist