Provider Demographics
NPI:1336664531
Name:AHMAD SOOLARI DMD PC
Entity Type:Organization
Organization Name:AHMAD SOOLARI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOLARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-785-5742
Mailing Address - Street 1:11616 TOULONE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3144
Mailing Address - Country:US
Mailing Address - Phone:301-798-5558
Mailing Address - Fax:
Practice Address - Street 1:11616 TOULONE DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3144
Practice Address - Country:US
Practice Address - Phone:301-798-5558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty