Provider Demographics
NPI:1730814104
Name:AMOOZADEH, SETAREH EMMA
Entity type:Individual
Prefix:DR
First Name:SETAREH
Middle Name:EMMA
Last Name:AMOOZADEH
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 1:1236 GULPH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4686
Mailing Address - Country:US
Mailing Address - Phone:949-610-4667
Mailing Address - Fax:
Practice Address - Street 1:1000 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5569
Practice Address - Country:US
Practice Address - Phone:215-944-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0437091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice