MEDICARE: SOROUR D.M.D 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1427562594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOROUR D.M.D CORPORATION

Provider Business Mailing Address
First Line	:	2156 E LINCOLN AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-4104
Country	:	US
Telephone Number	:	714-399-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	2156 E LINCOLN AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-4104
Country	:	US
Telephone Number	:	714-399-3140
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THARWAT SOROUR
Credential	:	DMD
Telephone Number	:	310-795-3363

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	03/17/2018

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