Provider Demographics
NPI:1891814760
Name:SOYSTER, MAILENE (DDS)
Entity type:Individual
Prefix:
First Name:MAILENE
Middle Name:
Last Name:SOYSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GREGORY LN STE 242
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2846
Mailing Address - Country:US
Mailing Address - Phone:925-689-1020
Mailing Address - Fax:315-454-8650
Practice Address - Street 1:401 GREGORY LN STE 242
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2846
Practice Address - Country:US
Practice Address - Phone:925-689-1020
Practice Address - Fax:315-454-8650
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051231-1122300000X
CA602821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist