Provider Demographics
NPI:1942305537
Name:SOBERANO, ARLENE D (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:D
Last Name:SOBERANO
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 1:2401 NEWNAN CROSSING BLVD E STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2409
Mailing Address - Country:US
Mailing Address - Phone:770-251-5777
Mailing Address - Fax:770-252-9347
Practice Address - Street 1:2401 NEWNAN CROSSING BLVD E STE 210
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2409
Practice Address - Country:US
Practice Address - Phone:770-251-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00826053Medicaid
GADN011836OtherSTATE DENTAL LICENSE