Provider Demographics
NPI:1528831781
Name:SOROURS DENTAL OFFICE CORPORATION
Entity type:Organization
Organization Name:SOROURS DENTAL OFFICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SELVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-795-3363
Mailing Address - Street 1:6633 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-2523
Mailing Address - Country:US
Mailing Address - Phone:323-456-7377
Mailing Address - Fax:
Practice Address - Street 1:17185 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3972
Practice Address - Country:US
Practice Address - Phone:909-587-2474
Practice Address - Fax:909-365-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty