Individual
DR. PETER THOMAS SODERSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
1605 TIMOTHY AVE STE A, MODESTO, CA 95350-4419
(209) 544-0404
(209) 544-1008
Mailing address
1605 TIMOTHY AVE STE A, MODESTO, CA 95350-4419
(209) 544-0404
(209) 544-1008
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
36835
CA
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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