Provider Demographics
NPI:1760034789
Name:DIEZ, SOALLET (DMD)
Entity type:Individual
Prefix:
First Name:SOALLET
Middle Name:
Last Name:DIEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 NORTHBROOKE PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8088
Mailing Address - Country:US
Mailing Address - Phone:239-593-6488
Mailing Address - Fax:
Practice Address - Street 1:2515 NORTHBROOKE PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8088
Practice Address - Country:US
Practice Address - Phone:239-593-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24793122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist