Provider Demographics
NPI:1669881546
Name:DOLATYAR, SEPIDEH (DDS)
Entity type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:DOLATYAR
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 1:3120 SAWTELLE BLVD APT 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1474
Mailing Address - Country:US
Mailing Address - Phone:424-800-1716
Mailing Address - Fax:
Practice Address - Street 1:1122 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5131
Practice Address - Country:US
Practice Address - Phone:424-800-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63615122300000X
NY0614481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics