Healthcare Provider Details

I. General information

NPI: 1043770217
Provider Name (Legal Business Name): SOROUSH SAMIMI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E COMMERCIAL BLVD
OAKLAND PARK FL
33334-3391
US

IV. Provider business mailing address

200 ALBERT SABIN WAY OFC 2220
CINCINNATI OH
45267-2800
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-2000
  • Fax:
Mailing address:
  • Phone: 513-584-2586
  • Fax: 513-584-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN29944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: