Provider Demographics
NPI:1306418389
Name:SONI, PRUTHA (DDS)
Entity Type:Individual
Prefix:
First Name:PRUTHA
Middle Name:
Last Name:SONI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1666
Mailing Address - Country:US
Mailing Address - Phone:330-741-0480
Mailing Address - Fax:
Practice Address - Street 1:3211 W NORTHWEST HWY # 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-5944
Practice Address - Country:US
Practice Address - Phone:972-128-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417301122300000X
TX371211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist