Provider Demographics
NPI:1831254671
Name:ESLAMPOUR, SONNY (DDS)
Entity type:Individual
Prefix:DR
First Name:SONNY
Middle Name:
Last Name:ESLAMPOUR
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 1:555 S RANCHO SANTA FE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-3698
Mailing Address - Country:US
Mailing Address - Phone:760-510-9009
Mailing Address - Fax:760-510-8008
Practice Address - Street 1:555 S RANCHO SANTA FE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-3698
Practice Address - Country:US
Practice Address - Phone:760-510-9009
Practice Address - Fax:760-510-8008
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice