Healthcare Provider Details

I. General information

NPI: 1437734118
Provider Name (Legal Business Name): SEPIDEH NOORANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WALNUT ST STE 402
PHILADELPHIA PA
19102-2903
US

IV. Provider business mailing address

251 S OLDS BLVD APT 63
FAIRLESS HILLS PA
19030-3424
US

V. Phone/Fax

Practice location:
  • Phone: 215-972-0181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS044088
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: