Healthcare Provider Details

I. General information

NPI: 1245884832
Provider Name (Legal Business Name): AREZOO SOTOODEH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-4124
US

IV. Provider business mailing address

411 E ESPANOLA ST
COLORADO SPRINGS CO
80907-7647
US

V. Phone/Fax

Practice location:
  • Phone: 719-260-6093
  • Fax: 719-260-2339
Mailing address:
  • Phone: 604-773-1367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number204093
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: