Healthcare Provider Details

I. General information

NPI: 1154744126
Provider Name (Legal Business Name): SOHEIL A SOLEIMANI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 E WASHINGTON ST STE B
COLTON CA
92324-4185
US

IV. Provider business mailing address

4411 REDONDO BEACH BLVD
LAWNDALE CA
90260-3465
US

V. Phone/Fax

Practice location:
  • Phone: 310-338-0444
  • Fax: 424-398-0156
Mailing address:
  • Phone: 310-802-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SOHEIL SOLEIMANI
Title or Position: OWNER
Credential:
Phone: 310-338-0444