MEDICARE: DR. LALEH SOTOODEH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	65084	CA

General Provider Information

NPI Number	:	1023329695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LALEH SOTOODEH DMD

Provider Business Mailing Address
First Line	:	770 TAMALPAIS DR STE 304
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1737
Country	:	US
Telephone Number	:	925-719-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	770 TAMALPAIS DR STE 304
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1737
Country	:	US
Telephone Number	:	925-719-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	01/20/2022

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