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General NPI Number Information
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NPI Number | 1669774592
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Entity Type | Organization
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Legal Business Name | IRADJ SOOUDI, D.M.D., P.C.
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 2018 BROOKWOOD MEDICAL CTR DR SUITE 309
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City | BIRMINGHAM
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State | AL
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Zip | 35209-6898
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Country | US
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Telephone | 205-877-2931
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Fax | 205-877-2780
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Provider Business Mailing Address
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Address Line | 2018 BROOKWOOD MEDICAL CTR DR SUITE 309
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City | BIRMINGHAM
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State | AL
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Zip | 35209-6898
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Country | US
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Telephone | 205-877-2931
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Fax | 205-877-2780
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Authorized Official
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Title or Position | DENTIST
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Name | DR. IRADJ SOOUDI
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Credential | M.D.
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Telephone | 205-877-2931
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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 | 3197
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License Number State | AL
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