Provider Demographics
NPI:1710042478
Name:KHODADADI, SOHEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:SOHEIL
Middle Name:
Last Name:KHODADADI
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 1:8641 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-271-3003
Mailing Address - Fax:310-271-6299
Practice Address - Street 1:8641 WILSHIRE BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-271-3003
Practice Address - Fax:310-271-6299
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4994T122300000X
CA390241223G0001X
TX262981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist