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Deactivated NPI 1093847121 Deactivated / Inactive NPI Male Practitioner

Dr. Andrew Phillip Soderstrom , DDS

Dentist - Pediatric Dentistry • Modesto, CA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Andrew Soderstrom has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 12, 2007
NPI Deactivation Date May 28, 2020
Total Practice Duration ~13 Years of Practice (2007 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Andrew Soderstrom, DDS was a registered Dentist - Pediatric Dentistry practicing in Modesto, CA. Throughout an active medical career spanning 13 years, Dr. Soderstrom provided care at the practice location at 1605 TIMOTHY AVE until profile deactivation on 2020-05-28.

Practice Location & Contact Primary Location

Practice Address

1605 Timothy Ave
Suite B

Modesto, CA 953504419

Telephone 2095795437

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - Pediatric Dentistry in Modesto, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 12.8 Yrs
Regional Practice Density
10 Specialists

Practicing in Modesto, CA (1373 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - Pediatric Dentistry Primary Specialty

NUCC Taxonomy Code: 1223P0221X

State License CA 31865

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated May 28, 2020

Record deactivated on May 28, 2020

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 1605 TIMOTHY AVE, SUITE B, MODESTO, CA 953504419 (Tel: 2095795437)

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Updated Business Mailing Address July 08, 2007

Registered at 1605 TIMOTHY AVE, SUITE B, MODESTO, CA 953504419 (Tel: 2095795437)

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Provider Name / Credentials Updated July 08, 2007

Recorded as ANDREW SODERSTROM, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #31865 in CA)

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Initial NPI Registration & Enumeration March 12, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1093847121
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 12, 2007
Last Update: July 08, 2007
Deactivation Date: May 28, 2020

Mailing Address

1605 Timothy Ave, Suite B

Modesto, CA 953504419

Phone: 2095795437

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.