Healthcare Provider Details

I. General information

NPI: 1700127859
Provider Name (Legal Business Name): SEPIDEH SAZEGARI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 STATE BRIDGE RD
JOHNS CREEK GA
30097-8220
US

IV. Provider business mailing address

5805 STATE BRIDGE RD
JOHNS CREEK GA
30097-8220
US

V. Phone/Fax

Practice location:
  • Phone: 678-474-4917
  • Fax:
Mailing address:
  • Phone: 678-474-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number05422
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN011779
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: