Provider Demographics
NPI:1578783197
Name:SOARES, STEVEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:SOARES
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 1:910 J ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4321
Mailing Address - Country:US
Mailing Address - Phone:209-826-2025
Mailing Address - Fax:209-826-2436
Practice Address - Street 1:910 J ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4321
Practice Address - Country:US
Practice Address - Phone:209-826-2025
Practice Address - Fax:209-826-2436
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice