Provider Demographics
NPI:1467684399
Name:SONNE FAMILY DENTAL, P.C.
Entity Type:Organization
Organization Name:SONNE FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ASST.
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUSKARICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-671-8414
Mailing Address - Street 1:1550 KINGSWAY CT
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1923
Mailing Address - Country:US
Mailing Address - Phone:734-671-8414
Mailing Address - Fax:734-671-8234
Practice Address - Street 1:1550 KINGSWAY CT
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1923
Practice Address - Country:US
Practice Address - Phone:734-671-8414
Practice Address - Fax:734-671-8234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:2901010486
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-11
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010104861223G0001X
MI29010178851223G0001X
MI29010191621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty