Basic Information
| Provider Information | |||||||||
| NPI: | 1437364288 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOLEIMAN PROFESSIONAL DENTAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800152 | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913800152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183897288 | ||||||||
| FaxNumber: | 8183861001 | ||||||||
| Practice Location | |||||||||
| Address1: | 24218 VALENCIA BLVD | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612880288 | ||||||||
| FaxNumber: | 6612869925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 12/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | SOLEIMAN | ||||||||
| AuthorizedOfficialFirstName: | BOBBY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8183897288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | S4-61C | NV | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Periodontics | 1223P0300X | 43860 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Periodontics |
No ID Information.