Provider Demographics
NPI:1144381062
Name:MASSOL-BURRIS, SONIA YADIRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:YADIRA
Last Name:MASSOL-BURRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SONIA
Other - Middle Name:YADIRA
Other - Last Name:MASSOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:201 E 37TH ST
Mailing Address - Street 2:L-2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3159
Mailing Address - Country:US
Mailing Address - Phone:212-883-9030
Mailing Address - Fax:212-883-9031
Practice Address - Street 1:201 E 37TH ST
Practice Address - Street 2:L-2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3159
Practice Address - Country:US
Practice Address - Phone:212-883-9030
Practice Address - Fax:212-883-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist