Provider Demographics
NPI:1134213770
Name:SOLTANI, POONEH (DDS)
Entity type:Individual
Prefix:DR
First Name:POONEH
Middle Name:
Last Name:SOLTANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 W 85TH STREET
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293
Mailing Address - Country:US
Mailing Address - Phone:310-301-2627
Mailing Address - Fax:
Practice Address - Street 1:5901 E. 7TH STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90293
Practice Address - Country:US
Practice Address - Phone:562-826-5407
Practice Address - Fax:562-826-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics