Provider Demographics
NPI:1548357478
Name:SOSA, ROBERTO (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:SOSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NW 57TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2018
Mailing Address - Country:US
Mailing Address - Phone:305-261-6965
Mailing Address - Fax:305-265-2089
Practice Address - Street 1:815 NW 57TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2018
Practice Address - Country:US
Practice Address - Phone:305-261-6965
Practice Address - Fax:305-265-2089
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00131791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice