Provider Demographics
NPI:1235616780
Name:VASANWALA, SONIYA SALIL (DMD)
Entity Type:Individual
Prefix:
First Name:SONIYA
Middle Name:SALIL
Last Name:VASANWALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 TOULOUSE
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4558
Mailing Address - Country:US
Mailing Address - Phone:815-735-4963
Mailing Address - Fax:
Practice Address - Street 1:890 RICHARD RD STE B
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1780
Practice Address - Country:US
Practice Address - Phone:815-735-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0315811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.031581OtherSTATE OF ILLINOIS