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General NPI Number Information
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NPI Number | 1457842957
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Entity Type | Organization
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Legal Business Name | SULIMAN ORTHODONTICS INC.
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 4534 PRECISSI LN STE C
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City | STOCKTON
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State | CA
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Zip | 95207-6213
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Country | US
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Telephone | 209-478-5168
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Fax | 209-478-2313
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Provider Business Mailing Address
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Address Line | 4534 PRECISSI LN STE C
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City | STOCKTON
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State | CA
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Zip | 95207-6213
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Country | US
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Telephone | 209-478-5168
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Fax | 209-478-2313
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Authorized Official
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Title or Position | CEO/DENTIST-ORTHODONTIST
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Name | DR. SAM SULIMAN
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Credential | DDS
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Telephone | 209-478-5168
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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 | 56348
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License Number State | CA
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