Provider Demographics
NPI:1750995353
Name:SOOLARI, AMIN SHAMS (DDS)
Entity type:Individual
Prefix:DR
First Name:AMIN
Middle Name:SHAMS
Last Name:SOOLARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 TOULONE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3144
Mailing Address - Country:US
Mailing Address - Phone:301-785-5222
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DR RM D1-19
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-4556
Practice Address - Country:US
Practice Address - Phone:352-273-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171261223G0001X
FLDN288441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice