Provider Demographics
NPI:1417349556
Name:ANDREI SOUCHITSKI D.D.S, INC.
Entity Type:Organization
Organization Name:ANDREI SOUCHITSKI D.D.S, INC.
Other - Org Name:MC ARTHUR PARK DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUCHITSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-858-4007
Mailing Address - Street 1:2007 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 525
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-858-4007
Mailing Address - Fax:213-858-4011
Practice Address - Street 1:2007 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3506
Practice Address - Country:US
Practice Address - Phone:213-928-7297
Practice Address - Fax:310-274-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty