Provider Demographics
NPI:1225198344
Name:SOS, JEAN-LOUIS ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:JEAN-LOUIS
Middle Name:ROBERT
Last Name:SOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3430
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-3430
Mailing Address - Country:US
Mailing Address - Phone:909-624-6199
Mailing Address - Fax:909-621-5635
Practice Address - Street 1:865 S INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5455
Practice Address - Country:US
Practice Address - Phone:909-624-6199
Practice Address - Fax:909-621-5635
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics