Provider Demographics
NPI:1679585244
Name:SODER, MARCIA A (DDS)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:SODER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 W 62ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2909
Mailing Address - Country:US
Mailing Address - Phone:317-293-5011
Mailing Address - Fax:317-291-7693
Practice Address - Street 1:6002 W 62ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2909
Practice Address - Country:US
Practice Address - Phone:317-293-5011
Practice Address - Fax:317-291-7693
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice