=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811516164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLORZANO AND SOTO DDS P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2020
-----------------------------------------------------
Last Update Date | 04/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14603 HUEBNER RD BLDG 14
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-5483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-906-8090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26002 DESTINY RDG
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78260-2573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-542-0387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER/OWNER
-----------------------------------------------------
Name | BRYAN EFRAIN SOTO
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 210-542-0387
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------