# DR. SCOTT SODERSTROM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1457326878
- **Gender:** Man
- **Credential:** D D S P C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00008668 | WA | Yes |

## Other

- **Enumeration date:** 02/20/2006
- **Last updated:** 01/29/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0150532 | LABOR AND INDUSTRIES ID\# | WA |
| 01 | — | 1287SO | BLUE CROSS | — |
| 01 | — | 174980063 | ADA NUMBER | — |
| 01 | — | 21933 | UNITED CONCORDIA ID | WA |
| 05 | — | 5037479 | — | WA |
| 01 | — | 602-040-560 | UNIFIED BUSINESS ID | WA |
| 01 | — | 91-2051287 | TAX ID \# | — |
| 01 | — | DE00008668 | STATE DENTAL LICENSE | WA |