Provider Demographics
NPI:1699195800
Name:JJ SAHOURIA, DDS, INC
Entity Type:Organization
Organization Name:JJ SAHOURIA, DDS, INC
Other - Org Name:SOCO DENTAL SPECIALTY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHOURIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:707-978-2077
Mailing Address - Street 1:1301 MEDICAL CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2902
Mailing Address - Country:US
Mailing Address - Phone:707-978-2077
Mailing Address - Fax:
Practice Address - Street 1:1301 MEDICAL CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2902
Practice Address - Country:US
Practice Address - Phone:707-978-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty