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General NPI Number Information
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NPI Number | 1467245423
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Entity Type | Individual
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Provider Name | TIMUR SOUCHISKI DMD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 06/01/2025
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Provider Practice Location Address
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Address Line | 5855 E STILL CIR
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City | MESA
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State | AZ
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Zip | 85206-3631
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Country | US
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Telephone | 480-248-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 417 S WETHERLY DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3519
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Country | US
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Telephone | 310-883-8707
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 111576
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License Number State | CA
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