Provider Demographics
NPI:1689916215
Name:MAGGARD, SONJA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:SONJA
Middle Name:L
Last Name:MAGGARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PROSPEROUS PL
Mailing Address - Street 2:SUITE 12 B
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1800
Mailing Address - Country:US
Mailing Address - Phone:859-263-1888
Mailing Address - Fax:859-263-0566
Practice Address - Street 1:121 PROSPEROUS PL
Practice Address - Street 2:SUITE 12 B
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1800
Practice Address - Country:US
Practice Address - Phone:859-263-1888
Practice Address - Fax:859-263-0566
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1619014560OtherTYPE 2 NPI FOR DR. SONJA L. MAGGARD