Provider Demographics
NPI:1679190250
Name:SOTO, NATHANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:NATHANIEL
Other - Middle Name:
Other - Last Name:SOTO-ROSADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:13040 LIVINGSTON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5026
Mailing Address - Country:US
Mailing Address - Phone:787-806-8494
Mailing Address - Fax:
Practice Address - Street 1:13040 LIVINGSTON RD STE 3
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-5026
Practice Address - Country:US
Practice Address - Phone:787-806-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25742122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice