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General NPI Number Information
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NPI Number | 1275756959
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Entity Type | Organization
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Legal Business Name | EDDIE SO, D.D.S., A DENTAL CORPORATION
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 41 E FOOTHILL BLVD STE 206
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City | ARCADIA
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State | CA
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Zip | 91006-2361
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Country | US
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Telephone | 626-445-6666
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Fax | 626-445-6668
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Provider Business Mailing Address
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Address Line | 41 E FOOTHILL BLVD STE 206
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City | ARCADIA
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State | CA
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Zip | 91006-2361
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Country | US
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Telephone | 626-445-6666
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Fax | 626-445-6668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDDIE N SO
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Credential | D.D.S.
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Telephone | 626-445-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | CA
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