Provider Demographics
NPI:1225519689
Name:SOROUR DMD DENTAL GROUP CORP
Entity Type:Organization
Organization Name:SOROUR DMD DENTAL GROUP CORP
Other - Org Name:ALL KIDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SELVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-795-3363
Mailing Address - Street 1:6633 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-2523
Mailing Address - Country:US
Mailing Address - Phone:323-456-7377
Mailing Address - Fax:323-456-7399
Practice Address - Street 1:9474 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5504
Practice Address - Country:US
Practice Address - Phone:562-803-4224
Practice Address - Fax:562-803-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty