Provider Demographics
NPI:1275652844
Name:GARDEN, SONJA KAE (DDS)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:KAE
Last Name:GARDEN
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 1:2522 DANA ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704
Mailing Address - Country:US
Mailing Address - Phone:510-644-0701
Mailing Address - Fax:510-644-0325
Practice Address - Street 1:2522 DANA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-644-0701
Practice Address - Fax:510-644-0325
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA404381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice