Provider Demographics
NPI:1164412441
Name:SONDAY, BRENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:SONDAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 FALCON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SCHRIEVER, AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 FALCON PARKWAY
Practice Address - Street 2:
Practice Address - City:SCHRIEVER, AFB
Practice Address - State:CO
Practice Address - Zip Code:80912
Practice Address - Country:US
Practice Address - Phone:719-567-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4620-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry