Provider Demographics
NPI:1184293409
Name:POOYA SOLTANZADEH, DDS, MS INC.
Entity type:Organization
Organization Name:POOYA SOLTANZADEH, DDS, MS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:POOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLTANZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:424-603-8394
Mailing Address - Street 1:5545 VIA VERANO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4931
Mailing Address - Country:US
Mailing Address - Phone:424-603-8394
Mailing Address - Fax:
Practice Address - Street 1:8101 E KAISER BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2261
Practice Address - Country:US
Practice Address - Phone:424-603-8394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental