Provider Demographics
NPI:1548096902
Name:DIPIETRO, SOPHIA LEILA (DDS)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:LEILA
Last Name:DIPIETRO
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 1:1418 TURQUOISE DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1246
Mailing Address - Country:US
Mailing Address - Phone:760-845-5762
Mailing Address - Fax:
Practice Address - Street 1:1418 TURQUOISE DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1246
Practice Address - Country:US
Practice Address - Phone:760-845-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1104481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics