Provider Demographics
NPI:1699381640
Name:ROBERT F. SONNTAG, D.D.S. PLLC
Entity Type:Organization
Organization Name:ROBERT F. SONNTAG, D.D.S. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:SONNTAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-790-3357
Mailing Address - Street 1:4400 FASHION SQUARE BLVD
Mailing Address - Street 2:PO BOX 5795
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603
Mailing Address - Country:US
Mailing Address - Phone:989-790-3357
Mailing Address - Fax:989-790-3443
Practice Address - Street 1:4400 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603
Practice Address - Country:US
Practice Address - Phone:989-790-3357
Practice Address - Fax:989-790-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2915010Medicaid