Healthcare Provider Details

I. General information

NPI: 1013275049
Provider Name (Legal Business Name): JULIO SOTILLO RODRIGUEZ D.D.S., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 25TH AVE S SUITE 400
MINNEAPOLIS MN
55454-1513
US

IV. Provider business mailing address

515 DELAWARE ST SE MOOS TOWER 6-650
MINNEAPOLIS MN
55455-0357
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-3249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD13124
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: