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General NPI Number Information
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NPI Number | 1245539006
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Entity Type | Individual
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Provider Name | CLARISSA SOTO CDA
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Gender | Female
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Dates
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Enumeration Date | 03/19/2011
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Last Update Date | 03/19/2011
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Provider Practice Location Address
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Address Line | 1001 LAUREL OAK RD STE C2
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City | VOORHEES
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State | NJ
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Zip | 08043-3512
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Country | US
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Telephone | 856-783-3515
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Fax | 856-783-3517
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Provider Business Mailing Address
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Address Line | 3030 GARFIELD AVE
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City | MILLVILLE
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State | NJ
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Zip | 08332-7641
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Country | US
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Telephone | 609-431-3394
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Fax | 856-367-7057
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 200076
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License Number State | NJ
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