MEDICARE: MUNA F SOLTAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	42423	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33-0652406	OTHER	CA	TAX ID

General Provider Information

NPI Number	:	1033185921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUNA F SOLTAN D.D.S.

Provider Business Mailing Address
First Line	:	P.O.BOX 2955
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624
Country	:	US
Telephone Number	:	909-910-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	21038 GOLDEN SPRINGS DR
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91789-3831
Country	:	US
Telephone Number	:	909-910-9990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	11/24/2015

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