Healthcare Provider Details

I. General information

NPI: 1114005030
Provider Name (Legal Business Name): AHMAD SADEGHEIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N CENTRAL AVE 750
GLENDALE CA
91203-3905
US

IV. Provider business mailing address

500 N CENTRAL AVE 750
GLENDALE CA
91203-3905
US

V. Phone/Fax

Practice location:
  • Phone: 818-551-5055
  • Fax: 818-246-2463
Mailing address:
  • Phone: 818-551-5055
  • Fax: 818-246-2463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number36219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: