Provider Demographics
NPI:1609202746
Name:NASH SOURIAL DDS INC
Entity Type:Organization
Organization Name:NASH SOURIAL DDS INC
Other - Org Name:BLU OASIS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NASH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOURIAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-342-2258
Mailing Address - Street 1:79845 HIGHWAY 111
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4758
Mailing Address - Country:US
Mailing Address - Phone:760-342-2258
Mailing Address - Fax:
Practice Address - Street 1:79845 HIGHWAY 111
Practice Address - Street 2:SUITE 101
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4758
Practice Address - Country:US
Practice Address - Phone:760-342-2258
Practice Address - Fax:760-342-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty