Provider Demographics
NPI:1659964872
Name:POYOUROW PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:POYOUROW PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:POYOUROW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD, MPH
Authorized Official - Phone:310-279-0993
Mailing Address - Street 1:4582 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2655
Mailing Address - Country:US
Mailing Address - Phone:310-279-0993
Mailing Address - Fax:
Practice Address - Street 1:1441 AVOCADO AVE STE 406
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7705
Practice Address - Country:US
Practice Address - Phone:949-760-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty