Provider Demographics
NPI:1265543920
Name:SOUCHITSKI, ANDREI SR (DDS)
Entity type:Individual
Prefix:
First Name:ANDREI
Middle Name:
Last Name:SOUCHITSKI
Suffix:SR
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3723
Mailing Address - Country:US
Mailing Address - Phone:213-749-3934
Mailing Address - Fax:213-749-0994
Practice Address - Street 1:514 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3723
Practice Address - Country:US
Practice Address - Phone:213-749-3934
Practice Address - Fax:213-749-0994
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA432491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice