Scott Soderstrom, D D S P C

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00008668 Issued in WA

Practice address

101 W Cascade Way
Suite 200
Spokane, WA 99208-6003

Phone

(509) 467-5202

Fax

(509) 466-0518

NPI assigned

Feb 20, 2006

Last updated

Jan 29, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1457326878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W CASCADE WAY",
            "address_2": "SUITE 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992086003",
            "telephone_number": "509-467-5202",
            "fax_number": "509-468-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W CASCADE WAY",
            "address_2": "SUITE 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992086003",
            "telephone_number": "509-467-5202",
            "fax_number": "509-466-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERSTROM",
        "first_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D D S P C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-20",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00008668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADA NUMBER",
            "identifier": "174980063",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES ID#",
            "identifier": "0150532",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL LICENSE",
            "identifier": "DE00008668",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIFIED BUSINESS ID",
            "identifier": "602-040-560",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1287SO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA ID",
            "identifier": "21933",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5037479",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "91-2051287",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riley Sobosky
• Mary Catherine Sobralske, PHD APRN
• Sochi Health and Wellness PLLC
• Social Treatment Opportunity Programs II, Inc. (STOP - Spokane)
• Social Treatment Opportunity Programs II, Inc. (Stop-Spokane)
• Mark M Sodorff, DDS
• Michelle M. Sodorff, PHARMD
• Pauline Soehren, ARNP
• Robert Soelter
• Eric A Sohn, MD

• General Practice Dentistry in Spokane, WA
• Providers in Spokane, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.