Provider Demographics
NPI:1154592756
Name:SOTO, ANGEL EDGARDO (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:EDGARDO
Last Name:SOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 FAIR OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4807
Mailing Address - Country:US
Mailing Address - Phone:916-979-7122
Mailing Address - Fax:916-979-7123
Practice Address - Street 1:6227 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4807
Practice Address - Country:US
Practice Address - Phone:916-979-7122
Practice Address - Fax:916-979-7123
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56302122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist