Provider Demographics
NPI:1932275062
Name:SETAREH, SEPEHR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEPEHR
Middle Name:
Last Name:SETAREH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 ROSCOMARE RD UNIT F17
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1840
Mailing Address - Country:US
Mailing Address - Phone:310-351-5153
Mailing Address - Fax:
Practice Address - Street 1:919 W AVENUE J STE C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3432
Practice Address - Country:US
Practice Address - Phone:661-949-8288
Practice Address - Fax:661-949-2455
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist