Provider Demographics
NPI:1790263689
Name:MARITES L. SOTTO, DDS, INC.
Entity Type:Organization
Organization Name:MARITES L. SOTTO, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITES
Authorized Official - Middle Name:LAGAZON
Authorized Official - Last Name:SOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-210-9677
Mailing Address - Street 1:890 EASTLAKE PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4522
Mailing Address - Country:US
Mailing Address - Phone:619-421-4521
Mailing Address - Fax:619-421-4529
Practice Address - Street 1:890 EASTLAKE PKWY STE 307
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4522
Practice Address - Country:US
Practice Address - Phone:619-421-4521
Practice Address - Fax:619-421-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58124261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental