Healthcare Provider Details

I. General information

NPI: 1407595317
Provider Name (Legal Business Name): IMAN SOLEYMANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 UNIVERSITY BLVD W STE 1010
SILVER SPRING MD
20902-5902
US

IV. Provider business mailing address

160 E ERIE AVE
PHILADELPHIA PA
19134-1011
US

V. Phone/Fax

Practice location:
  • Phone: 240-752-8822
  • Fax: 240-752-8821
Mailing address:
  • Phone: 215-427-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401418252
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401418252
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18519
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: