Provider Demographics
NPI:1477946846
Name:ESSEX DENTAL, PRACTICE OF SULEIMANAGICH DENTAL CORPERATION
Entity Type:Organization
Organization Name:ESSEX DENTAL, PRACTICE OF SULEIMANAGICH DENTAL CORPERATION
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMER
Authorized Official - Middle Name:ALE
Authorized Official - Last Name:SULEIMANAGICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-553-8188
Mailing Address - Street 1:9911 W PICO BLVD
Mailing Address - Street 2:#950
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2703
Mailing Address - Country:US
Mailing Address - Phone:310-553-8188
Mailing Address - Fax:
Practice Address - Street 1:9911 W PICO BLVD
Practice Address - Street 2:#950
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2703
Practice Address - Country:US
Practice Address - Phone:310-553-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty