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General NPI Number Information
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NPI Number | 1588038327
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Entity Type | Organization
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Legal Business Name | SOROUSHIAN AND TAQAVI DENTAL CORPORATION
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 3125 COFFEE RD STE 4
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City | MODESTO
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State | CA
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Zip | 95355-1768
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Country | US
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Telephone | 209-526-8182
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Fax | 209-526-8214
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Provider Business Mailing Address
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Address Line | 3125 COFFEE RD STE 4
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City | MODESTO
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State | CA
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Zip | 95355-1768
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Country | US
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Telephone | 209-526-8182
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Fax | 209-526-8214
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. POOYA SOROOSHIAN
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Credential |
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Telephone | 925-876-4680
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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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