Healthcare Provider Details

I. General information

NPI: 1467199521
Provider Name (Legal Business Name): TARLAN SEDAGHAT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 LOMAS SANTA FE DR STE A
SOLANA BEACH CA
92075-1346
US

IV. Provider business mailing address

1136 D AVE
NATIONAL CITY CA
91950-3412
US

V. Phone/Fax

Practice location:
  • Phone: 858-876-9100
  • Fax:
Mailing address:
  • Phone: 619-662-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDDS109445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: