Provider Demographics
NPI:1427562594
Name:SOROUR D.M.D CORPORATION
Entity Type:Organization
Organization Name:SOROUR D.M.D CORPORATION
Other - Org Name:JUNGLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THARWAT
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 1:2156 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4104
Mailing Address - Country:US
Mailing Address - Phone:714-399-3140
Mailing Address - Fax:
Practice Address - Street 1:2156 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4104
Practice Address - Country:US
Practice Address - Phone:714-399-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty