Provider Demographics
NPI:1245539006
Name:SOTO, CLARISSA (CDA)
Entity type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-7641
Mailing Address - Country:US
Mailing Address - Phone:609-431-3394
Mailing Address - Fax:856-367-7057
Practice Address - Street 1:1001 LAUREL OAK RD STE C2
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3512
Practice Address - Country:US
Practice Address - Phone:856-783-3515
Practice Address - Fax:856-783-3517
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ200076126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ639755OtherDENTAL RADIOGRAPHY LICENSE
NJ200076OtherCERTIFIED DENTAL ASSISTANT