Provider Demographics
NPI:1083080097
Name:ESMAILIAN LARI, SOMA (DMD)
Entity Type:Individual
Prefix:
First Name:SOMA
Middle Name:
Last Name:ESMAILIAN LARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics