Provider Demographics
NPI:1457530164
Name:SEDAGHATFAR, MICHAEL (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SEDAGHATFAR
Suffix:
Gender:
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:SEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:711 D ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3707
Mailing Address - Country:US
Mailing Address - Phone:415-482-9901
Mailing Address - Fax:415-482-9902
Practice Address - Street 1:711 D ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3707
Practice Address - Country:US
Practice Address - Phone:415-482-9901
Practice Address - Fax:415-482-9902
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics