Provider Demographics
NPI:1578962254
Name:PATEL, SONAM SHAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SONAM
Middle Name:SHAH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SONAM
Other - Middle Name:VIPULKUMAR
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5147 MOUNT CLARE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4477
Mailing Address - Country:US
Mailing Address - Phone:704-804-4129
Mailing Address - Fax:
Practice Address - Street 1:17214 LANCASTER HWY STE 301
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2093
Practice Address - Country:US
Practice Address - Phone:704-703-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95271223P0221X
NC2601681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FS6413758OtherDEA