Provider Demographics
NPI:1588948228
Name:SOTO-GONZALEZ, NATHALEE (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHALEE
Middle Name:
Last Name:SOTO-GONZALEZ
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901 TURNERS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1529
Mailing Address - Country:US
Mailing Address - Phone:574-272-0466
Mailing Address - Fax:
Practice Address - Street 1:17901 TURNERS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1529
Practice Address - Country:US
Practice Address - Phone:574-272-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0198860.021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice