Provider Demographics
NPI:1033298831
Name:CARRAM, SOFIA CRISTINA
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:CRISTINA
Last Name:CARRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5311
Mailing Address - Country:US
Mailing Address - Phone:201-837-7629
Mailing Address - Fax:
Practice Address - Street 1:263 CROOKS AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1614
Practice Address - Country:US
Practice Address - Phone:973-685-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020645001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice