MEDICARE: DR. SEPIDEH SABOOREE MD, DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	92077	GA
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DGD.10930	SC
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	4917	AR
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DN21538	FL
5	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	14122	NC

General Provider Information

NPI Number	:	1114310943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEPIDEH SABOOREE MD, DMD

Provider Business Mailing Address
First Line	:	365 BRYNFIELD PKWY
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-2985
Country	:	US
Telephone Number	:	404-626-0063
Fax Number	:

Provider Business Practice Location Address
First Line	:	960115 GATEWAY BLVD STE 1
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-9129
Country	:	US
Telephone Number	:	904-491-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2015
Last Update Date	:	06/03/2026

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