Provider Demographics
NPI:1700206406
Name:SONES FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:SONES FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-656-0608
Mailing Address - Street 1:21 GLEN ED PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3333
Mailing Address - Country:US
Mailing Address - Phone:618-656-0608
Mailing Address - Fax:618-656-0615
Practice Address - Street 1:21 GLEN ED PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3333
Practice Address - Country:US
Practice Address - Phone:618-656-0608
Practice Address - Fax:618-656-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028342122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty