Provider Demographics
NPI:1669082012
Name:SOHEIL A SOLEIMANI DENTAL CORP
Entity type:Organization
Organization Name:SOHEIL A SOLEIMANI DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SOLEIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-338-0444
Mailing Address - Street 1:4411 REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3465
Mailing Address - Country:US
Mailing Address - Phone:310-338-0444
Mailing Address - Fax:424-398-0156
Practice Address - Street 1:5795 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-7336
Practice Address - Country:US
Practice Address - Phone:310-572-6167
Practice Address - Fax:310-572-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty