Provider Demographics
NPI:1073211298
Name:SONI, MOHIT PRAGNESHKUMAR (DDS)
Entity Type:Individual
Prefix:
First Name:MOHIT
Middle Name:PRAGNESHKUMAR
Last Name:SONI
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 1:3792 VENICE GRV
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3914
Mailing Address - Country:US
Mailing Address - Phone:586-224-6572
Mailing Address - Fax:
Practice Address - Street 1:5198 N NEVADA AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8649
Practice Address - Country:US
Practice Address - Phone:719-634-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO171504639OtherDRIVER LICENSE