Healthcare Provider Details

I. General information

NPI: 1649509910
Provider Name (Legal Business Name): AMIR SEDAGHAT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BOND ST
GREAT NECK NY
11021-2025
US

IV. Provider business mailing address

23 BOND ST
GREAT NECK NY
11021-2025
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-4777
  • Fax: 516-829-1476
Mailing address:
  • Phone: 516-482-4777
  • Fax: 516-829-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number47836-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: