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General NPI Number Information
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NPI Number | 1245473370
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Entity Type | Organization
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Legal Business Name | PAYAM SOOFERI D.D.S., A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 207 N CENTRAL AVE
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City | GLENDALE
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State | CA
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Zip | 91203-2510
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Country | US
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Telephone | 818-243-8888
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Fax | 818-243-8808
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Provider Business Mailing Address
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Address Line | 207 N CENTRAL AVE
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City | GLENDALE
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State | CA
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Zip | 91203-2510
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Country | US
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Telephone | 818-243-8888
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Fax | 818-243-8808
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. PAYAM SOOFERI
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Credential | D.D.S.
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Telephone | 818-243-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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