Provider Demographics
NPI:1417334095
Name:SONI, RINI
Entity Type:Individual
Prefix:
First Name:RINI
Middle Name:
Last Name:SONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5656
Mailing Address - Country:US
Mailing Address - Phone:404-717-4727
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1213
Practice Address - Country:US
Practice Address - Phone:410-799-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist