Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 36963 | TX |
NPI | 1003404849 |
---|---|
Provider Name | Soheil Karbassi |
First Address | Fremont, CA 94537-0017 |
Second Address | Odessa, TX 79762-7338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2021 |
Last Update Date | 16/02/2021 |