Provider Demographics
NPI:1417595000
Name:RATHORE, SONALI ANIL
Entity Type:Individual
Prefix:DR
First Name:SONALI
Middle Name:ANIL
Last Name:RATHORE
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 1:3812 PUMPKIN SEED LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5956
Mailing Address - Country:US
Mailing Address - Phone:919-360-2832
Mailing Address - Fax:
Practice Address - Street 1:3812 PUMPKIN SEED LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5956
Practice Address - Country:US
Practice Address - Phone:919-360-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014133321223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology