Healthcare Provider Details

I. General information

NPI: 1184265365
Provider Name (Legal Business Name): MARIA ANDREA BORDOY SOTO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BEE STREET 2ND FLOOR MSC 507
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

29 BEE STREET 2ND FLOOR MSC 507
CHARLESTON SC
29425-0001
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-6272
  • Fax: 843-792-1280
Mailing address:
  • Phone: 843-792-6272
  • Fax: 843-792-1280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number74
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: