Individual
MRS. CLARISSA SOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDA
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
200076
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200076
CERTIFIED DENTAL ASSISTANT
NJ
01
—
639755
DENTAL RADIOGRAPHY LICENSE
NJ
Enumeration date
03/19/2011
Last updated
03/19/2011
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