Provider Demographics
NPI:1932244738
Name:SORIA, JUAN OMAR (DDS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:OMAR
Last Name:SORIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3758 83RD STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7142
Mailing Address - Country:US
Mailing Address - Phone:718-458-2880
Mailing Address - Fax:718-685-7588
Practice Address - Street 1:3758 83RD STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7142
Practice Address - Country:US
Practice Address - Phone:718-458-2880
Practice Address - Fax:718-685-7588
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice