Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 1042 | OK |
NPI | 1356525943 |
---|---|
Provider Name | Pedro M Soto |
First Address | Skiatook, OK 74070-0724 |
Second Address | Skiatook, OK 74070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 19/12/2007 |