Provider Demographics
NPI:1023329695
Name:SOTOODEH, LALEH (DMD)
Entity type:Individual
Prefix:DR
First Name:LALEH
Middle Name:
Last Name:SOTOODEH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 TAMALPAIS DR STE 304
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1737
Mailing Address - Country:US
Mailing Address - Phone:925-719-0111
Mailing Address - Fax:
Practice Address - Street 1:770 TAMALPAIS DR STE 304
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1737
Practice Address - Country:US
Practice Address - Phone:925-719-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist