Elizabeth Sotomil DDS, Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ELIZABETH SOTOMIL DDS, INC

Practice address

3609 Coffee Rd Ste 3
Modesto, CA 95355-1100

Phone

(209) 526-1190

Fax

(209) 526-3245

NPI assigned

Mar 27, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Elizabeth Manzo Sotomil, DDSNPI 1154629566

Title

Owner

Phone

(209) 526-1190

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Smile Harvest Dental Former legal business name

Electronic endpoints 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Manzo Sotomil

  • Dentist
  • Modesto, CA
  • NPI 1154629566
  NPD Authorized official
• Larry Scott Lewis, DDS

  • General Practice Dentistry
  • Modesto, CA
  • NPI 1215146105
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566345600000",
    "number": "1184185753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3609 COFFEE RD STE 3",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551100",
            "telephone_number": "209-526-1190",
            "fax_number": "209-526-3245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3609 COFFEE RD STE 3",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551100",
            "telephone_number": "209-526-1190",
            "fax_number": "209-526-3245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH SOTOMIL DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-27",
        "last_updated": "2019-08-21",
        "status": "A",
        "authorized_official_last_name": "SOTOMIL",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "MANZO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-526-1190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154629566",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "smileharvestdental@gmail.com",
            "affiliation": "N",
            "address_1": "3609 Coffee Rd Ste 3",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953551100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Smile Harvest Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Dental Clinic/Center in Modesto, CA
• Providers in Modesto, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.