Provider Demographics
NPI:1063728368
Name:B. SOUFERIAN DDS PC
Entity type:Organization
Organization Name:B. SOUFERIAN DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:SOUFERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:050040
Authorized Official - Phone:718-921-0111
Mailing Address - Street 1:8301 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4402
Mailing Address - Country:US
Mailing Address - Phone:718-921-0111
Mailing Address - Fax:718-921-7254
Practice Address - Street 1:8301 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4402
Practice Address - Country:US
Practice Address - Phone:718-921-0111
Practice Address - Fax:718-921-7254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty