Provider Demographics
NPI:1699931394
Name:SOURIAL, NASH (DDS)
Entity type:Individual
Prefix:
First Name:NASH
Middle Name:
Last Name:SOURIAL
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:PO BOX 5393
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-5393
Mailing Address - Country:US
Mailing Address - Phone:760-342-2258
Mailing Address - Fax:
Practice Address - Street 1:79845 HIGHWAY 111
Practice Address - Street 2:SUITE 101
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4758
Practice Address - Country:US
Practice Address - Phone:760-342-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist