Provider Demographics
NPI:1639528011
Name:SOTO, ADRIAN ESTEBAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:ESTEBAN
Last Name:SOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADRIAN
Other - Middle Name:
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:501 S. MADISON
Mailing Address - Street 2:SUITE P
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870
Mailing Address - Country:US
Mailing Address - Phone:417-392-6090
Mailing Address - Fax:
Practice Address - Street 1:501 S.MADISON
Practice Address - Street 2:SUITE P
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870
Practice Address - Country:US
Practice Address - Phone:417-392-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160184761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice