Provider Demographics
NPI:1417135641
Name:SOGA, NADINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:
Last Name:SOGA
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 1:1234 19TH STREET NW
Mailing Address - Street 2:SUITE 710
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2441
Mailing Address - Country:US
Mailing Address - Phone:202-783-3450
Mailing Address - Fax:202-785-7337
Practice Address - Street 1:1234 19TH STREET NW
Practice Address - Street 2:SUITE 710
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2441
Practice Address - Country:US
Practice Address - Phone:202-783-3450
Practice Address - Fax:202-785-7337
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC48891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice