MEDICARE: ALBERT L. SOULEMA, DDS, A PROFESSIONAL CORPORATION

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1295421097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERT L. SOULEMA, DDS, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	16632 DIAMANTE DR
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	543 COUNTRY CLUB DR STE C
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-7696
Country	:	US
Telephone Number	:	818-968-1491
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ALBERT SOULEMA
Credential	:	DDS
Telephone Number	:	818-968-1491

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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