Basic Information
| Provider Information | |||||||||
| NPI: | 1992051346 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUMAVA SEN, DDS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145716481 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6000 CAMP BOWIE BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761165606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175852475 | ||||||||
| FaxNumber: | 8175852484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2012 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | VARGAS | ||||||||
| AuthorizedOfficialFirstName: | PEGGY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7145716481 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.