Provider Demographics
NPI:1982081071
Name:SOUDABEH SHARAFI DMD INC.
Entity Type:Organization
Organization Name:SOUDABEH SHARAFI DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOUDABEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-291-1700
Mailing Address - Street 1:2367 E VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2715
Mailing Address - Country:US
Mailing Address - Phone:760-291-1700
Mailing Address - Fax:760-291-1717
Practice Address - Street 1:2367 E VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2715
Practice Address - Country:US
Practice Address - Phone:760-291-1700
Practice Address - Fax:760-291-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty