Provider Demographics
NPI:1427690825
Name:PEDRAM SOOFERI DDS, INC
Entity type:Organization
Organization Name:PEDRAM SOOFERI DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:EIN
Authorized Official - Last Name:SOOFERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-645-6033
Mailing Address - Street 1:8930 S SEPULVEDA BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3606
Mailing Address - Country:US
Mailing Address - Phone:310-645-6033
Mailing Address - Fax:310-410-0990
Practice Address - Street 1:8930 S SEPULVEDA BLVD STE 118
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3606
Practice Address - Country:US
Practice Address - Phone:310-645-6033
Practice Address - Fax:310-410-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental