Provider Demographics
NPI:1508268558
Name:SOHAIL M. EBRAHIMI DDS INC
Entity Type:Organization
Organization Name:SOHAIL M. EBRAHIMI DDS INC
Other - Org Name:SOHAIL M. EBRAHIMI DDS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:EBRAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-365-4626
Mailing Address - Street 1:801 WOODSIDE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3751
Mailing Address - Country:US
Mailing Address - Phone:650-365-4626
Mailing Address - Fax:650-365-4625
Practice Address - Street 1:801 WOODSIDE RD STE 3
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3751
Practice Address - Country:US
Practice Address - Phone:650-365-4626
Practice Address - Fax:650-365-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental