Healthcare Provider Details

I. General information

NPI: 1316140734
Provider Name (Legal Business Name): SOLEIMANI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10732 RIVERSIDE DR
N HOLLYWOOD CA
91602-2313
US

IV. Provider business mailing address

10732 RIVERSIDE DRIVE
N HOLLYWOOD CA
91602
US

V. Phone/Fax

Practice location:
  • Phone: 818-760-9494
  • Fax: 818-760-9696
Mailing address:
  • Phone: 818-760-9494
  • Fax: 818-760-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37922
License Number StateCA

VIII. Authorized Official

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