Provider Demographics
NPI:1184834715
Name:SOHEIL PISHGAR LEVI DDS INC
Entity Type:Organization
Organization Name:SOHEIL PISHGAR LEVI DDS INC
Other - Org Name:LAKE ELSINORE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-674-6808
Mailing Address - Street 1:32235 MISSION TR
Mailing Address - Street 2:#8
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530
Mailing Address - Country:US
Mailing Address - Phone:951-674-6808
Mailing Address - Fax:951-674-2668
Practice Address - Street 1:32235 MISSION TR
Practice Address - Street 2:#8
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530
Practice Address - Country:US
Practice Address - Phone:951-674-6808
Practice Address - Fax:951-674-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223E0200X, 1223G0001X, 1223P0300X
CA373381223P0221X
CA520571223P0700X
CA452621223S0112X
CA231251223X0400X
CA391951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty