Provider Demographics
NPI:1992728398
Name:SOLTANI, MOHAMMAD HADI (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HADI
Last Name:SOLTANI
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 1:1932 VISTA DEL RIO
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:CA
Mailing Address - Zip Code:94525
Mailing Address - Country:US
Mailing Address - Phone:775-771-1310
Mailing Address - Fax:
Practice Address - Street 1:1932 VISTA DEL RIO
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525
Practice Address - Country:US
Practice Address - Phone:775-771-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV460512430OtherBLUE CROSS
NV460512430OtherAETNA
NV357OtherUNITED CONCORDIA
NV460512430OtherCIGNA
NV460512430OtherBENEFIT PLANNERS
NV460512430OtherDELTA DENTAL
NV460512430OtherMET LIFE