Provider Demographics
NPI:1477994770
Name:SOROUSHIAN, VASNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VASNA
Middle Name:
Last Name:SOROUSHIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E CENTRAL TEXAS EXPY
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5606
Mailing Address - Country:US
Mailing Address - Phone:925-323-2862
Mailing Address - Fax:254-698-3590
Practice Address - Street 1:500 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5606
Practice Address - Country:US
Practice Address - Phone:925-323-2862
Practice Address - Fax:254-698-3590
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist