Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1376218966 |
---|---|
Provider Name | Cesar Soto Betancourt |
First Address | Great Falls, MT 59405 |
Second Address | Great Falls, MT 59405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 16/08/2021 |