Provider Demographics
NPI:1265086631
Name:SOTO, GABRIELA (DMD)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:SOTO
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 1:13951 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3002
Mailing Address - Country:US
Mailing Address - Phone:954-661-3079
Mailing Address - Fax:
Practice Address - Street 1:11741 S CLEVELAND AVE STE 30
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2854
Practice Address - Country:US
Practice Address - Phone:239-465-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN244661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice