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NPI Code Detail

MEDICARE: DR. AREZOO SOTOODEH DMD

MEDICARE: DR. AREZOO 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
1122300000XDentist204093CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10367431OTHERDRIVER'S LICENSE

General Provider Information

NPI Number : 1245884832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AREZOO SOTOODEH DMD
Provider Business Mailing Address
First Line : 411 E ESPANOLA ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7647
Country : US
Telephone Number : 604-773-1367
Fax Number :
Provider Business Practice Location Address
First Line : 5050 N ACADEMY BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-4124
Country : US
Telephone Number : 719-260-6093
Fax Number : 719-260-2339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2019
Last Update Date : 07/31/2019

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Directions to “ DR. AREZOO SOTOODEH DMD” Practice Location

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