Provider Demographics
NPI:1114735677
Name:MARIAM SOLDIN-WASFI DMD PROFESSIONAL CORP
Entity type:Organization
Organization Name:MARIAM SOLDIN-WASFI DMD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLDIN-WASFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-278-9449
Mailing Address - Street 1:31105 RANCHO VIEJO RD STE C2
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1717
Mailing Address - Country:US
Mailing Address - Phone:949-218-3607
Mailing Address - Fax:
Practice Address - Street 1:31105 RANCHO VIEJO RD STE C2
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1717
Practice Address - Country:US
Practice Address - Phone:949-218-3607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental