Healthcare Provider Details

I. General information

NPI: 1457508921
Provider Name (Legal Business Name): SORAYA M BEIRAGHI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 EXCELSIOR BLVD
MINNEAPOLIS MN
55416-4600
US

IV. Provider business mailing address

515 DELAWARE ST SE 6TH FLOOR MOOS T
MINNEAPOLIS MN
55455-0357
US

V. Phone/Fax

Practice location:
  • Phone: 612-306-4037
  • Fax:
Mailing address:
  • Phone: 612-624-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberFF15
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: