MEDICARE: DR. ELLIOTT PARKER SOTO 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	30026614	OH
2	1223G0001X	General Practice Dentistry	27826	FL
3	122300000X	Dentist	DN27826	FL

General Provider Information

NPI Number	:	1518634625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOTT PARKER SOTO DMD

Provider Business Mailing Address
First Line	:	3716 W NEPTUNE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5119
Country	:	US
Telephone Number	:	813-254-1007
Fax Number	:

Provider Business Practice Location Address
First Line	:	3716 W NEPTUNE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5119
Country	:	US
Telephone Number	:	813-254-1007
Fax Number	:	813-254-1177

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

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	04/10/2025

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