Healthcare Provider Details

I. General information

NPI: 1841891652
Provider Name (Legal Business Name): SOROUR DMD DENTAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N LONG BEACH BLVD
COMPTON CA
90221-1610
US

IV. Provider business mailing address

6633 ATLANTIC AVE
BELL CA
90201-2523
US

V. Phone/Fax

Practice location:
  • Phone: 310-639-5000
  • Fax:
Mailing address:
  • Phone: 323-456-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SELVANA SOROUR
Title or Position: VICE PRESIDENT
Credential: DMD
Phone: 310-795-3363