Provider Demographics
NPI:1730178948
Name:SOOTIN, DOUGLAS ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:SOOTIN
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 1:136 S IRVING ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4548
Mailing Address - Country:US
Mailing Address - Phone:201-670-9286
Mailing Address - Fax:201-612-7555
Practice Address - Street 1:19 OLD MAMARONECK RD
Practice Address - Street 2:SUITE A
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1748
Practice Address - Country:US
Practice Address - Phone:914-946-4455
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice