Provider Demographics
NPI:1316925373
Name:SOTELO, PABLO E (DMD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:E
Last Name:SOTELO
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 1:9523 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2812
Mailing Address - Country:US
Mailing Address - Phone:215-331-5757
Mailing Address - Fax:215-331-6615
Practice Address - Street 1:9523 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2812
Practice Address - Country:US
Practice Address - Phone:215-331-5757
Practice Address - Fax:215-331-6615
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030460L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA203029027OtherTAX IDENTIFICATION NUMBER