MEDICARE: DR. VASNA SOROUSHIAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	29323	TX

General Provider Information

NPI Number	:	1477994770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASNA SOROUSHIAN DDS

Provider Business Mailing Address
First Line	:	500 E CENTRAL TEXAS EXPY
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5606
Country	:	US
Telephone Number	:	925-323-2862
Fax Number	:	254-698-3590

Provider Business Practice Location Address
First Line	:	500 E CENTRAL TEXAS EXPY
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5606
Country	:	US
Telephone Number	:	925-323-2862
Fax Number	:	254-698-3590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/15/2013

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