Provider Demographics
NPI:1376767475
Name:BONG-THAKUR, SARAH SOHYUN (DDS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SOHYUN
Last Name:BONG-THAKUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:SOHYUN
Other - Last Name:BONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1005 W 120TH AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2747
Mailing Address - Country:US
Mailing Address - Phone:720-263-5420
Mailing Address - Fax:
Practice Address - Street 1:1005 W 120TH AVE STE 800
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2747
Practice Address - Country:US
Practice Address - Phone:720-263-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118921223S0112X
CO002038021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery