Provider Demographics
NPI:1356525943
Name:SOTO, PEDRO M (DDM)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:M
Last Name:SOTO
Suffix:
Gender:M
Credentials:DDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-0724
Mailing Address - Country:US
Mailing Address - Phone:918-396-4002
Mailing Address - Fax:918-396-4002
Practice Address - Street 1:4996 1/2 W ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070
Practice Address - Country:US
Practice Address - Phone:918-396-4002
Practice Address - Fax:918-396-4002
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1042122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist