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NPI Code Detail

MEDICARE: SOUMAVA SEN, DDS, P.C.

MEDICARE: SOUMAVA SEN, DDS, P.C.
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
1122300000XDentist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619214764
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUMAVA SEN, DDS, P.C.
Provider Business Mailing Address
First Line : 530 S MAIN ST
Second Line :
City : ORANGE
State : CA
Zip : 92868-4525
Country : US
Telephone Number : 714-571-6493
Fax Number : 714-571-6445
Provider Business Practice Location Address
First Line : 3411 SYCAMORE SCHOOL RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-3030
Country : US
Telephone Number : 817-918-3295
Fax Number : 817-918-3304
Authorized Official
Title or Position : OWNER
Name : SOUMAVA SEN
Credential :
Telephone Number : 714-480-3000
Provider Enumeration Date : 01/09/2013
Last Update Date : 01/11/2013

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