MEDICARE: ANDREI SOUCHITSKI SR. DDS

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	43249	GA

General Provider Information

NPI Number	:	1265543920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREI SOUCHITSKI SR. DDS

Provider Business Mailing Address
First Line	:	514 E WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3723
Country	:	US
Telephone Number	:	213-749-3934
Fax Number	:	213-749-0994

Provider Business Practice Location Address
First Line	:	514 E WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3723
Country	:	US
Telephone Number	:	213-749-3934
Fax Number	:	213-749-0994

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	04/07/2025

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