Provider Demographics
NPI:1497456370
Name:SOLMAZ FORUTAN, DMD, INC.
Entity Type:Organization
Organization Name:SOLMAZ FORUTAN, DMD, INC.
Other - Org Name:FORTUNE SMILES DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLMAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FORUTAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:608-628-7492
Mailing Address - Street 1:5595 WINFIELD BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1220
Mailing Address - Country:US
Mailing Address - Phone:408-365-7767
Mailing Address - Fax:
Practice Address - Street 1:5595 WINFIELD BLVD STE 212
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1220
Practice Address - Country:US
Practice Address - Phone:408-365-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental