Healthcare Provider Details

I. General information

NPI: 1134504319
Provider Name (Legal Business Name): LADY CATHERINE SOTELO D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 E WALNUT AVE
DALTON GA
30721-4552
US

IV. Provider business mailing address

2107 E WALNUT AVE
DALTON GA
30721-4552
US

V. Phone/Fax

Practice location:
  • Phone: 706-428-0235
  • Fax:
Mailing address:
  • Phone: 706-428-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN015040
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: