Provider Demographics
NPI:1740010966
Name:SODHI, PRABHMEHAR (DDS)
Entity type:Individual
Prefix:
First Name:PRABHMEHAR
Middle Name:
Last Name:SODHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 OLDENBURG DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7472
Mailing Address - Country:US
Mailing Address - Phone:925-858-1818
Mailing Address - Fax:
Practice Address - Street 1:2025 REDWOOD RD STE 3
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3278
Practice Address - Country:US
Practice Address - Phone:707-255-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1104021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice