Provider Demographics
NPI:1396226262
Name:BANERJEE, SONALI (DMD)
Entity Type:Individual
Prefix:DR
First Name:SONALI
Middle Name:
Last Name:BANERJEE
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 1:9295 RIVERSIDE PKWY APT T
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7341
Mailing Address - Country:US
Mailing Address - Phone:918-625-0014
Mailing Address - Fax:
Practice Address - Street 1:5510 E 41ST ST STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6009
Practice Address - Country:US
Practice Address - Phone:918-994-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice