Healthcare Provider Details

I. General information

NPI: 1164573614
Provider Name (Legal Business Name): SOL ZIRA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W BEVERLY BLVD
MONTEBELLO CA
90640-1536
US

IV. Provider business mailing address

13055 HESBY ST
SHERMAN OAKS CA
91423-2133
US

V. Phone/Fax

Practice location:
  • Phone: 323-722-6766
  • Fax:
Mailing address:
  • Phone: 818-788-4954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: