Healthcare Provider Details

I. General information

NPI: 1801715214
Provider Name (Legal Business Name): BENJAMINE ASUNCION SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 FOLEY BLVD NW STE 110
MINNEAPOLIS MN
55433-5216
US

IV. Provider business mailing address

2717 FERNWOOD STREET NORTH
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 763-317-1166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15484
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: