Provider Demographics
NPI:1619182037
Name:SORIANO, ROY DAGAMAT (DDS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:DAGAMAT
Last Name:SORIANO
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 1:16652 DESERT LILY ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14084 AMARGOSA RD
Practice Address - Street 2:SUITE D270
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2486
Practice Address - Country:US
Practice Address - Phone:760-596-4253
Practice Address - Fax:760-596-4256
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist