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General NPI Number Information
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NPI Number | 1033873203
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Entity Type | Individual
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Provider Name | SOGOL SEGHATOLESLAMI DDS. MS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/30/2021
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Provider Practice Location Address
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Address Line | 8305 W QUINAULT AVE
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City | KENNEWICK
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State | WA
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Zip | 99336-1138
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Country | US
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Telephone | 509-628-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 725 N CENTER PKWY APT F201
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City | KENNEWICK
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State | WA
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Zip | 99336-8224
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Country | US
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Telephone | 949-540-3871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE61187204
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License Number State | WA
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