Provider Demographics
NPI:1841293594
Name:SEDAGHATPOUR, MEHRSHID (DDS)
Entity type:Individual
Prefix:DR
First Name:MEHRSHID
Middle Name:
Last Name:SEDAGHATPOUR
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 1:26 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2322
Mailing Address - Country:US
Mailing Address - Phone:917-833-8446
Mailing Address - Fax:516-487-0382
Practice Address - Street 1:17 MAPLE DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2000
Practice Address - Country:US
Practice Address - Phone:516-487-8747
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0495351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics