Provider Demographics
NPI:1225196686
Name:SALMANPOUR SOHI, ALI REZA (DDS)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:REZA
Last Name:SALMANPOUR SOHI
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 1:188 EAST LITTLE CANADA ROAD
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1332
Mailing Address - Country:US
Mailing Address - Phone:651-484-7725
Mailing Address - Fax:651-484-7768
Practice Address - Street 1:188 EAST LITTLE CANADA ROAD
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1332
Practice Address - Country:US
Practice Address - Phone:651-484-7725
Practice Address - Fax:651-484-7768
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND1100551223G0001X
CA521991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice