Provider Demographics
NPI:1801079066
Name:SOODABEH AZARMI DDS INC
Entity type:Organization
Organization Name:SOODABEH AZARMI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOODABEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZARMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-837-8087
Mailing Address - Street 1:4310 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4117
Mailing Address - Country:US
Mailing Address - Phone:310-837-8087
Mailing Address - Fax:310-837-8096
Practice Address - Street 1:4310 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4117
Practice Address - Country:US
Practice Address - Phone:310-837-8087
Practice Address - Fax:310-837-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39938OtherDENTI-CAL PROVIDER