Provider Demographics
NPI:1194897876
Name:SOTERAS, ANA T (DDS,PA)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:T
Last Name:SOTERAS
Suffix:
Gender:F
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SW 142ND AVE
Mailing Address - Street 2:4827 NW 183RD ST
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8014
Mailing Address - Country:US
Mailing Address - Phone:305-225-2530
Mailing Address - Fax:305-225-6411
Practice Address - Street 1:2701 SW 142ND AVE
Practice Address - Street 2:4827 NW 183RD ST
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8014
Practice Address - Country:US
Practice Address - Phone:305-225-2530
Practice Address - Fax:305-225-6411
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-00135531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075-055-701Medicaid
FL075055700Medicaid