Provider Demographics
NPI:1134504319
Name:SOTELO, LADY CATHERINE (DMD)
Entity Type:Individual
Prefix:
First Name:LADY
Middle Name:CATHERINE
Last Name:SOTELO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4552
Mailing Address - Country:US
Mailing Address - Phone:706-428-0235
Mailing Address - Fax:
Practice Address - Street 1:2107 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4552
Practice Address - Country:US
Practice Address - Phone:706-428-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist