Provider Demographics
NPI:1811049315
Name:PEJHAM, SEPIDEH (DDS)
Entity type:Individual
Prefix:DR
First Name:SEPIDEH
Middle Name:
Last Name:PEJHAM
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 1:12948 VILLAGE DR
Mailing Address - Street 2:#3
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4157
Mailing Address - Country:US
Mailing Address - Phone:408-255-9057
Mailing Address - Fax:408-255-3031
Practice Address - Street 1:12948 VILLAGE DR
Practice Address - Street 2:#3
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4157
Practice Address - Country:US
Practice Address - Phone:408-255-9057
Practice Address - Fax:408-255-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice