Healthcare Provider Details

I. General information

NPI: 1225519689
Provider Name (Legal Business Name): SOROUR DMD DENTAL GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9474 FIRESTONE BLVD
DOWNEY CA
90241-5504
US

IV. Provider business mailing address

6633 ATLANTIC AVE
BELL CA
90201-2523
US

V. Phone/Fax

Practice location:
  • Phone: 562-803-4224
  • Fax: 562-803-3574
Mailing address:
  • Phone: 323-456-7377
  • Fax: 323-456-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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