=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831351758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANA SOTERAS D.D.S, P.A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2008
-----------------------------------------------------
Last Update Date | 07/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4827 NW 183RD ST
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33055-2955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-622-2622
-----------------------------------------------------
Fax | 305-622-3445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4827 NW 183RD ST
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33055-2955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-622-2622
-----------------------------------------------------
Fax | 305-622-3445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ANA T SOTERAS
-----------------------------------------------------
Credential | D.D.S, P.A
-----------------------------------------------------
Telephone | 305-622-2622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN13553
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------