Healthcare Provider Details

I. General information

NPI: 1770830192
Provider Name (Legal Business Name): STEFANIE JEAN SOTELLO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANIE SOTELLO HOURANI DDS

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 N 44TH ST SUITE 101
PHOENIX AZ
85018-2782
US

IV. Provider business mailing address

4017 E PATRICIA JANE DR
PHOENIX AZ
85018-3753
US

V. Phone/Fax

Practice location:
  • Phone: 602-595-3531
  • Fax: 602-595-3531
Mailing address:
  • Phone: 402-650-0686
  • Fax: 602-595-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD008533
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD008533
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: