Provider Demographics
NPI:1578771317
Name:SOOD, AMIT (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:SOOD
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 1:8131 BAXTER AVE
Mailing Address - Street 2:# LB
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1315
Mailing Address - Country:US
Mailing Address - Phone:718-429-0877
Mailing Address - Fax:
Practice Address - Street 1:8131 BAXTER AVE
Practice Address - Street 2:# LB
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1315
Practice Address - Country:US
Practice Address - Phone:718-429-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0435371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice