Provider Demographics
NPI:1942522487
Name:SONI-GAUR, SHUBHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHUBHA
Middle Name:
Last Name:SONI-GAUR
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 1:860 E JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7505
Mailing Address - Country:US
Mailing Address - Phone:631-673-8040
Mailing Address - Fax:
Practice Address - Street 1:860 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7505
Practice Address - Country:US
Practice Address - Phone:631-673-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry