Provider Demographics
NPI:1497168223
Name:SOTER, JOHN-CLEEVE ANDREW (DMD)
Entity type:Individual
Prefix:
First Name:JOHN-CLEEVE
Middle Name:ANDREW
Last Name:SOTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11858 E FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5716
Mailing Address - Country:US
Mailing Address - Phone:617-319-2530
Mailing Address - Fax:
Practice Address - Street 1:RENEW 1-DAY DENTURES
Practice Address - Street 2:8770 N UNION BLVD
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-597-8484
Practice Address - Fax:719-597-2031
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002029961223P0700X
CODEN.00202996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics