Individual
MEHRDAD SOHEILIMOGHADAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
132 WILDER WAY, NORTH WALES, PA 19454-1532
(310) 760-6042
Mailing address
132 WILDER WAY, NORTH WALES, PA 19454-1532
(310) 760-6042
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401414790
VA
1223P0300X
Periodontics
Primary
0401414790
VA
Other
Enumeration date
04/09/2015
Last updated
04/09/2015
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