Individual
DR. MARY JEAN SOTACK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3105 WESTERN BRANCH BLVD, SUITE 6, CHESAPEAKE, VA 23321-5540
(757) 484-7503
(757) 483-7711
Mailing address
3105 WESTERN BRANCH BLVD, SUITE 6, CHESAPEAKE, VA 23321-5540
(757) 484-7503
(757) 483-7711
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
007555
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
095420
BCBS
VA
01
—
726210
DELTA RR CARE UNITED CONC
VA
Enumeration date
12/20/2005
Last updated
07/08/2007
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