MEDICARE: DR. SEPIDEH SAJADI 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	1223G0001X	General Practice Dentistry	DN25163	FL
2	1223E0200X	Endodontics	DN25163	FL
3	122300000X	Dentist	019.033568	IL
4	122300000X	Dentist	DN25163	FL

General Provider Information

NPI Number	:	1922626787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEPIDEH SAJADI DMD

Provider Business Mailing Address
First Line	:	555 NE 8TH ST APT 1802
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2998
Country	:	US
Telephone Number	:	917-900-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 NE 8TH ST APT 1802
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2998
Country	:	US
Telephone Number	:	917-900-8787
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/17/2024

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