Provider Demographics
NPI:1194851956
Name:SOUMI, JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:SOUMI
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 1:3575 S TOWN CENTER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3046
Mailing Address - Country:US
Mailing Address - Phone:702-869-5700
Mailing Address - Fax:702-869-6657
Practice Address - Street 1:3575 S TOWN CENTER DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-3046
Practice Address - Country:US
Practice Address - Phone:702-869-5700
Practice Address - Fax:702-869-6657
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice