Provider Demographics
NPI:1770830192
Name:SOTELLO, STEFANIE JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:JEAN
Last Name:SOTELLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEFANIE
Other - Middle Name:SOTELLO
Other - Last Name:HOURANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4017 E PATRICIA JANE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3753
Mailing Address - Country:US
Mailing Address - Phone:402-650-0686
Mailing Address - Fax:602-595-3531
Practice Address - Street 1:4901 N 44TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2782
Practice Address - Country:US
Practice Address - Phone:602-595-3531
Practice Address - Fax:602-595-3531
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0085331223D0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ885285Medicaid