Provider Demographics
NPI:1639321052
Name:R PETER SONNTAG DDS PLLC
Entity Type:Organization
Organization Name:R PETER SONNTAG DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SONNTAG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-564-1102
Mailing Address - Street 1:4130 REDWOOD LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3295
Mailing Address - Country:US
Mailing Address - Phone:719-564-1102
Mailing Address - Fax:
Practice Address - Street 1:4130 REDWOOD LN
Practice Address - Street 2:SUITE 130
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3295
Practice Address - Country:US
Practice Address - Phone:719-564-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty