Healthcare Provider Details

I. General information

NPI: 1467245423
Provider Name (Legal Business Name): TIMUR SOUCHISKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 06/01/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 E STILL CIR
MESA AZ
85206-3631
US

IV. Provider business mailing address

417 S WETHERLY DR
BEVERLY HILLS CA
90211-3519
US

V. Phone/Fax

Practice location:
  • Phone: 480-248-8100
  • Fax:
Mailing address:
  • Phone: 310-883-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: