Provider Demographics
NPI:1629457320
Name:SOTO & SOTO DENTAL PARTNERS, PLLC
Entity Type:Organization
Organization Name:SOTO & SOTO DENTAL PARTNERS, PLLC
Other - Org Name:SOTO DENTAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OBED
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-779-2621
Mailing Address - Street 1:11125 LA QUINTA PLACE
Mailing Address - Street 2:SUITE C&D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-779-2621
Mailing Address - Fax:915-779-2634
Practice Address - Street 1:2311 N. MESA ST.
Practice Address - Street 2:STE H
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-532-3651
Practice Address - Fax:915-779-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340121802Medicaid