Provider Demographics
NPI:1245397355
Name:SOEGAARD, ASTRID (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:
Last Name:SOEGAARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011
Mailing Address - Country:US
Mailing Address - Phone:818-790-5531
Mailing Address - Fax:818-790-5533
Practice Address - Street 1:747 FOOTHILL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3438
Practice Address - Country:US
Practice Address - Phone:818-790-5531
Practice Address - Fax:818-790-5533
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice