Provider Demographics
NPI:1275756959
Name:EDDIE SO, D.D.S., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:EDDIE SO, D.D.S., A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-445-6666
Mailing Address - Street 1:41 E FOOTHILL BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2361
Mailing Address - Country:US
Mailing Address - Phone:626-445-6666
Mailing Address - Fax:626-445-6668
Practice Address - Street 1:41 E FOOTHILL BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2361
Practice Address - Country:US
Practice Address - Phone:626-445-6666
Practice Address - Fax:626-445-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty