Provider Demographics
NPI:1831684323
Name:KHALEGHI, SANAZ
Entity type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:
Last Name:KHALEGHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TENNESSEE ST APT 113
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5421
Mailing Address - Country:US
Mailing Address - Phone:954-993-1286
Mailing Address - Fax:
Practice Address - Street 1:11 TENNESSEE ST APT 113
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5421
Practice Address - Country:US
Practice Address - Phone:954-993-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist