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General NPI Number Information
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NPI Number | 1124187901
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Entity Type | Individual
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Provider Name | MITRA PARTOW-SOROUSHI
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Gender | Female
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 6202 W PARK BLVD STE B
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City | PLANO
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State | TX
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Zip | 75093-6218
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Country | US
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Telephone | 972-403-7364
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Fax | 972-403-7161
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Provider Business Mailing Address
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Address Line | 6202B W PARK BLVD STE B
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City | PLANO
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State | TX
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Zip | 75093-6204
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Country | US
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Telephone | 972-403-7364
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Fax | 972-403-1761
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18192
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License Number State | TX
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