Provider Demographics
NPI:1053758904
Name:SADEHKHOU, ARDY (DDS)
Entity type:Individual
Prefix:DR
First Name:ARDY
Middle Name:
Last Name:SADEHKHOU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:1212
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3906
Mailing Address - Country:US
Mailing Address - Phone:310-443-4000
Mailing Address - Fax:310-870-9765
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:1212
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-443-4000
Practice Address - Fax:310-870-9765
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008720122300000X
CA62460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist