MEDICARE: DR. OBED SOTO DDS

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	30019	TX

General Provider Information

NPI Number	:	1558775353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OBED SOTO DDS

Provider Business Mailing Address
First Line	:	11125 LA QUINTA PL STE D
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5254
Country	:	US
Telephone Number	:	915-779-2621
Fax Number	:

Provider Business Practice Location Address
First Line	:	11125 LA QUINTA PL STE D
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5254
Country	:	US
Telephone Number	:	915-779-2621
Fax Number	:

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

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	07/10/2025

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