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General NPI Number Information
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NPI Number | 1861718827
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Entity Type | Individual
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Provider Name | SANAM SOROUDI
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Gender | Female
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 8764 RESEARCH BLVD STE D
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City | AUSTIN
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State | TX
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Zip | 78758-8540
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Country | US
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Telephone | 737-802-3822
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Fax |
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Provider Business Mailing Address
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Address Line | 4316 TOPANGA CANYON BLVD
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-5238
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33623
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License Number State | TX
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