Provider Demographics
NPI:1588399141
Name:SHOKOUH-AMIRI, SOLOMON (DDS)
Entity type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:
Last Name:SHOKOUH-AMIRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 EVERNIA ST APT 611
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5466
Mailing Address - Country:US
Mailing Address - Phone:901-800-6520
Mailing Address - Fax:
Practice Address - Street 1:11151 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4255
Practice Address - Country:US
Practice Address - Phone:561-246-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27258390200000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program