Provider Demographics
NPI:1770182495
Name:SOSA, PRISCILLA G (DMD)
Entity Type:Individual
Prefix:MISS
First Name:PRISCILLA
Middle Name:G
Last Name:SOSA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4923
Mailing Address - Country:US
Mailing Address - Phone:941-822-5759
Mailing Address - Fax:
Practice Address - Street 1:3848 SUN CITY CENTER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6843
Practice Address - Country:US
Practice Address - Phone:813-633-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist