Provider Demographics
NPI:1245884832
Name:SOTOODEH, AREZOO (DMD)
Entity type:Individual
Prefix:DR
First Name:AREZOO
Middle Name:
Last Name:SOTOODEH
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 1:411 E ESPANOLA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7647
Mailing Address - Country:US
Mailing Address - Phone:604-773-1367
Mailing Address - Fax:
Practice Address - Street 1:5050 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4124
Practice Address - Country:US
Practice Address - Phone:719-260-6093
Practice Address - Fax:719-260-2339
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO204093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0367431OtherDRIVER'S LICENSE