Healthcare Provider Details

I. General information

NPI: 1912370040
Provider Name (Legal Business Name): MONA SOLIMAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 CAMINO DE LOS MARES #501
SAN CLEMENTE CA
92673-2835
US

IV. Provider business mailing address

401 ROCKEFELLER APT 1209
IRVINE CA
92612-7186
US

V. Phone/Fax

Practice location:
  • Phone: 949-248-2524
  • Fax: 949-248-0909
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59530
License Number StateCA

VIII. Authorized Official

Name: DR. MONA SOLIMAN
Title or Position: DENTIST
Credential: DDS
Phone: 818-484-0962