Provider Demographics
NPI:1386056588
Name:SOTO, RITA (DDA)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:DDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78900 AVENUE 47 STE 110
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2070
Mailing Address - Country:US
Mailing Address - Phone:760-771-8334
Mailing Address - Fax:
Practice Address - Street 1:78900 AVENUE 47 STE 110
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2070
Practice Address - Country:US
Practice Address - Phone:760-771-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry