Provider Demographics
NPI:1366988404
Name:SOHO- SENIOR ORAL HEALTH OUTREACH
Entity type:Organization
Organization Name:SOHO- SENIOR ORAL HEALTH OUTREACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOURANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-650-0686
Mailing Address - Street 1:4901 N 44TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2782
Mailing Address - Country:US
Mailing Address - Phone:480-779-0227
Mailing Address - Fax:
Practice Address - Street 1:4901 N 44TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2782
Practice Address - Country:US
Practice Address - Phone:480-779-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD085331223P0221X, 261QD0000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty