Provider Demographics
NPI:1235659301
Name:SOLEIMANI, SHIVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:SOLEIMANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 TAMPA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2290
Mailing Address - Country:US
Mailing Address - Phone:727-781-6224
Mailing Address - Fax:
Practice Address - Street 1:3144 TAMPA RD STE 3
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2290
Practice Address - Country:US
Practice Address - Phone:727-781-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty