Provider Demographics
NPI:1023211448
Name:SOHEIL SOLEIMANI DMD CORP
Entity Type:Organization
Organization Name:SOHEIL SOLEIMANI DMD CORP
Other - Org Name:DENTALOGY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLEIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-338-0444
Mailing Address - Street 1:11444 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066
Mailing Address - Country:US
Mailing Address - Phone:310-572-6167
Mailing Address - Fax:310-572-1019
Practice Address - Street 1:11444 W WASHINGTON BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:310-572-6167
Practice Address - Fax:310-572-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty