Healthcare Provider Details

I. General information

NPI: 1033202817
Provider Name (Legal Business Name): WILLIAM THOMAS SOUTO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1798 WASHINGTON ST
DUBUQUE IA
52001-3659
US

IV. Provider business mailing address

1655 MAIN ST
DUBUQUE IA
52001-4511
US

V. Phone/Fax

Practice location:
  • Phone: 563-690-2850
  • Fax:
Mailing address:
  • Phone: 563-583-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number08349
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: