Provider Demographics
NPI:1336289594
Name:SOUTO-ACERO, JOSE R (DMD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:SOUTO-ACERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E 56TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-8642
Mailing Address - Country:US
Mailing Address - Phone:212-889-1313
Mailing Address - Fax:212-308-5885
Practice Address - Street 1:127 E 56TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-8642
Practice Address - Country:US
Practice Address - Phone:212-889-1313
Practice Address - Fax:212-308-5885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04442311223G0001X
NY05008811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery