Provider Demographics
NPI:1306258967
Name:SADEGHEIN, NEGAR
Entity type:Individual
Prefix:
First Name:NEGAR
Middle Name:
Last Name:SADEGHEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 DABNEY LN
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-2603
Mailing Address - Country:US
Mailing Address - Phone:626-818-9651
Mailing Address - Fax:
Practice Address - Street 1:11965 PELLICANO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6829
Practice Address - Country:US
Practice Address - Phone:915-855-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31674122300000X, 1223P0221X
390200000X
CA100026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program