Provider Demographics
NPI:1396360285
Name:DAI, MICHAEL SONNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SONNY
Last Name:DAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S MILITARY RD APT 26
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-2647
Mailing Address - Country:US
Mailing Address - Phone:318-344-1135
Mailing Address - Fax:
Practice Address - Street 1:640 BROWNSWITCH RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1234
Practice Address - Country:US
Practice Address - Phone:985-643-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice