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General NPI Number Information
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NPI Number | 1518093111
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Entity Type | Organization
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Legal Business Name | SHAHRYAR SEFIDPOUR,DDS MSD INC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 4150 DOUGLAS BLVD STE B
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City | GRANITE BAY
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State | CA
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Zip | 95746-5908
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Country | US
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Telephone | 916-774-6986
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Fax | 916-774-6533
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Provider Business Mailing Address
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Address Line | 4150 DOUGLAS BLVD STE B
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City | GRANITE BAY
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State | CA
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Zip | 95746-5908
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Country | US
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Telephone | 916-774-6986
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Fax | 916-774-6533
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Authorized Official
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Title or Position | OWNER / DOCTOR
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Name | DR. SHAHRYAR SEFIDPOUR
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Credential | DDS,MSD
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Telephone | 916-774-6986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 98442
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License Number State | CA
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