Provider Demographics
NPI:1073672879
Name:SOROUR, THARWAT (DMD)
Entity type:Individual
Prefix:DR
First Name:THARWAT
Middle Name:
Last Name:SOROUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7534 W 85TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8801
Mailing Address - Country:US
Mailing Address - Phone:562-437-0646
Mailing Address - Fax:562-432-7935
Practice Address - Street 1:1150 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3663
Practice Address - Country:US
Practice Address - Phone:562-437-0646
Practice Address - Fax:562-432-7935
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist