Provider Demographics
NPI:1295969517
Name:SOTTO, MARITES LAGAZON (DDS)
Entity type:Individual
Prefix:DR
First Name:MARITES
Middle Name:LAGAZON
Last Name:SOTTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 CAMINITO DE LA CRUZ
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3925
Mailing Address - Country:US
Mailing Address - Phone:808-741-4025
Mailing Address - Fax:
Practice Address - Street 1:1907 CAMINITO DE LA CRUZ
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3925
Practice Address - Country:US
Practice Address - Phone:808-741-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist