Provider Demographics
NPI:1447694260
Name:DOOSTZADEH, SAHAR (DMD)
Entity type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:
Last Name:DOOSTZADEH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PHAEDRA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-9044
Mailing Address - Country:US
Mailing Address - Phone:949-836-4805
Mailing Address - Fax:
Practice Address - Street 1:25500 RANCHO NIGUEL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7302
Practice Address - Country:US
Practice Address - Phone:949-831-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA622821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry