Provider Demographics
NPI:1760815856
Name:SOROUSHIAN, SHEILA (DMD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SOROUSHIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PALERMO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7315
Mailing Address - Country:US
Mailing Address - Phone:949-413-4828
Mailing Address - Fax:
Practice Address - Street 1:10 PALERMO
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7315
Practice Address - Country:US
Practice Address - Phone:949-413-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics