Basic Information
| Provider Information | |||||||||
| NPI: | 1497863534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLEIMAN | ||||||||
| FirstName: | BOBBY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2345 STRATFORD CIR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900771318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183897288 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 40770 CALIFORNIA OAKS RD | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925625727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516773078 | ||||||||
| FaxNumber: | 9516000498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 06/08/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 00202465 | CO | N | Dental Providers | Dentist | Periodontics | 1223P0300X | S4-61C | NV | N | Dental Providers | Dentist | Periodontics | 1223P0300X | DE60568675 | WA | N | Dental Providers | Dentist | Periodontics | 1223P0300X | D10296 | OR | N | Dental Providers | Dentist | Periodontics | 1223P0300X | 9578186-9921 | UT | N | Dental Providers | Dentist | Periodontics | 1223P0300X | S128 | MN | N | Dental Providers | Dentist | Periodontics | 1223P0300X | 2017011750 | MO | N | Dental Providers | Dentist | Periodontics | 1223P0300X | 43860 | CA | Y | Dental Providers | Dentist | Periodontics | 1223P0700X | 61328 | KS | N | Dental Providers | Dentist | Prosthodontics |
No ID Information.