Provider Demographics
NPI:1205269875
Name:SADEGHI, JANET MAYA (DDS)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:MAYA
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 1:1710 PURDUE AVE
Mailing Address - Street 2:#201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4258
Mailing Address - Country:US
Mailing Address - Phone:310-691-3953
Mailing Address - Fax:
Practice Address - Street 1:1710 PURDUE AVE
Practice Address - Street 2:#201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4258
Practice Address - Country:US
Practice Address - Phone:310-691-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA628461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice