Provider Demographics
NPI:1558810663
Name:SORIANO, MICHELLE (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SORIANO
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19110 BOTHELL WAY NE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2970
Mailing Address - Country:US
Mailing Address - Phone:425-482-9211
Mailing Address - Fax:
Practice Address - Street 1:19110 BOTHELL WAY NE STE 101
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2970
Practice Address - Country:US
Practice Address - Phone:425-482-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE608825121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty