Provider Demographics
NPI:1205679628
Name:SOTO, RODRIGO (DDS)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 OLD TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3341
Mailing Address - Country:US
Mailing Address - Phone:703-731-7414
Mailing Address - Fax:
Practice Address - Street 1:112 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2414
Practice Address - Country:US
Practice Address - Phone:703-731-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014189821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice