Provider Demographics
NPI:1063856672
Name:SOLEYMANI, PEIMAN (DDS)
Entity Type:Individual
Prefix:
First Name:PEIMAN
Middle Name:
Last Name:SOLEYMANI
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 1:416 N BEDFORD DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4322
Mailing Address - Country:US
Mailing Address - Phone:310-275-4606
Mailing Address - Fax:310-623-9106
Practice Address - Street 1:416 N BEDFORD DR
Practice Address - Street 2:SUITE 209
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4322
Practice Address - Country:US
Practice Address - Phone:310-275-4606
Practice Address - Fax:310-623-9106
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-07-25
Deactivation Date:2013-06-05
Deactivation Code:
Reactivation Date:2013-07-25
Provider Licenses
StateLicense IDTaxonomies
CA444441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty