Healthcare Provider Details

I. General information

NPI: 1457842957
Provider Name (Legal Business Name): SULIMAN ORTHODONTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534 PRECISSI LN STE C
STOCKTON CA
95207-6213
US

IV. Provider business mailing address

4534 PRECISSI LN STE C
STOCKTON CA
95207-6213
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-5168
  • Fax: 209-478-2313
Mailing address:
  • Phone: 209-478-5168
  • Fax: 209-478-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number56348
License Number StateCA

VIII. Authorized Official

Name: DR. SAM SULIMAN
Title or Position: CEO/DENTIST-ORTHODONTIST
Credential: DDS
Phone: 209-478-5168