Provider Demographics
NPI:1669194445
Name:DHOLAKIA, SONU BHARAT
Entity type:Individual
Prefix:
First Name:SONU
Middle Name:BHARAT
Last Name:DHOLAKIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 STONEWOOD DR APT 1922
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5276
Mailing Address - Country:US
Mailing Address - Phone:281-705-6364
Mailing Address - Fax:
Practice Address - Street 1:5826 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5820
Practice Address - Country:US
Practice Address - Phone:281-705-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice