Provider Demographics
NPI:1386089787
Name:SEDGHI-BERENJI, GOLNAR S (DDS)
Entity type:Individual
Prefix:MRS
First Name:GOLNAR
Middle Name:S
Last Name:SEDGHI-BERENJI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 OCOTILLO DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4217
Mailing Address - Country:US
Mailing Address - Phone:760-337-8868
Mailing Address - Fax:760-337-8898
Practice Address - Street 1:1501 OCOTILLO DR STE A
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4217
Practice Address - Country:US
Practice Address - Phone:760-337-8868
Practice Address - Fax:760-337-8898
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2015-02-11
Deactivation Date:2013-12-03
Deactivation Code:
Reactivation Date:2015-02-11
Provider Licenses
StateLicense IDTaxonomies
CA44256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist