Provider Demographics
NPI:1861885311
Name:SOTO, JOSE ALFREDO (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALFREDO
Last Name:SOTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:ALFREDO
Other - Last Name:SOTO-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6509
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2522
Mailing Address - Country:US
Mailing Address - Phone:602-872-3709
Mailing Address - Fax:
Practice Address - Street 1:2383 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7709
Practice Address - Country:US
Practice Address - Phone:602-872-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0094441223G0001X
CADDS1045151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice