Provider Demographics
NPI:1205072634
Name:SADEGHI, MIRJANA (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRJANA
Middle Name:
Last Name:SADEGHI
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 1:143-05 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1860
Mailing Address - Country:US
Mailing Address - Phone:718-606-2126
Mailing Address - Fax:
Practice Address - Street 1:14305 41ST AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1860
Practice Address - Country:US
Practice Address - Phone:718-606-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist