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General NPI Number Information
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NPI Number | 1538480579
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Entity Type | Individual
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Provider Name | DEREK DONALD SODEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone |
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Fax |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 58305
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License Number State | CA
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