Provider Demographics
NPI:1588273791
Name:SULAIMAN, MEHREEN (DMD)
Entity type:Individual
Prefix:
First Name:MEHREEN
Middle Name:
Last Name:SULAIMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LA CRESCENTA DR UNIT 229
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-6430
Mailing Address - Country:US
Mailing Address - Phone:562-312-8680
Mailing Address - Fax:
Practice Address - Street 1:71949 HIGHWAY 111 STE 100B
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4826
Practice Address - Country:US
Practice Address - Phone:760-565-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA1072271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program