Provider Demographics
NPI:1801812474
Name:SADRIAN, SEDIGHEH ROYA (DDS)
Entity type:Individual
Prefix:DR
First Name:SEDIGHEH
Middle Name:ROYA
Last Name:SADRIAN
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 1:12778 RANCHO PENASQUITOS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2947
Mailing Address - Country:US
Mailing Address - Phone:858-780-9794
Mailing Address - Fax:858-780-9690
Practice Address - Street 1:12778 RANCHO PENASQUITOS BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2947
Practice Address - Country:US
Practice Address - Phone:858-780-9794
Practice Address - Fax:858-780-9690
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry