Provider Demographics
NPI:1184763427
Name:SETAREH, ADIB (DDS)
Entity type:Individual
Prefix:MR
First Name:ADIB
Middle Name:
Last Name:SETAREH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18055 LAKE ENCINO DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4431
Mailing Address - Country:US
Mailing Address - Phone:323-734-9514
Mailing Address - Fax:323-734-0465
Practice Address - Street 1:1565 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4233
Practice Address - Country:US
Practice Address - Phone:323-734-9514
Practice Address - Fax:323-734-0465
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist