Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 12991 | MD |
NPI | 1144322017 |
---|---|
Provider Name | Ahmad Soolari |
First Address | Potomac, MD 20854-3144 |
Second Address | Potomac, MD 20854-3144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 08/07/2007 |