Provider Demographics
NPI:1205337763
Name:JOSE M. SOSA, DDS, INC.
Entity type:Organization
Organization Name:JOSE M. SOSA, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-730-0168
Mailing Address - Street 1:1235 W VISTA WAY STE L
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6234
Mailing Address - Country:US
Mailing Address - Phone:760-730-0168
Mailing Address - Fax:760-730-0189
Practice Address - Street 1:1235 W VISTA WAY STE L
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6234
Practice Address - Country:US
Practice Address - Phone:760-730-0168
Practice Address - Fax:760-730-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56379261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental