Provider Demographics
NPI:1043910847
Name:SOMA ESMAILIAN LARI DMD INC
Entity Type:Organization
Organization Name:SOMA ESMAILIAN LARI DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESMAILIAN LARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-925-8080
Mailing Address - Street 1:6803 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2710
Mailing Address - Country:US
Mailing Address - Phone:818-925-8080
Mailing Address - Fax:818-925-2340
Practice Address - Street 1:6803 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2710
Practice Address - Country:US
Practice Address - Phone:818-925-8080
Practice Address - Fax:818-925-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty