Provider Demographics
NPI:1841400264
Name:SONNEBORN-TURNOCK, AMY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:SONNEBORN-TURNOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52840 HIDDEN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7912
Mailing Address - Country:US
Mailing Address - Phone:574-271-0059
Mailing Address - Fax:574-259-1536
Practice Address - Street 1:1902 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-5614
Practice Address - Country:US
Practice Address - Phone:574-259-1563
Practice Address - Fax:574-259-1536
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009267A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist