Provider Demographics
NPI:1801109160
Name:HASIJA, SONAM (DDS, MPH, BDS,)
Entity type:Individual
Prefix:
First Name:SONAM
Middle Name:
Last Name:HASIJA
Suffix:
Gender:F
Credentials:DDS, MPH, BDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PRESTON ST
Mailing Address - Street 2:1E
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2500
Mailing Address - Country:US
Mailing Address - Phone:860-296-1500
Mailing Address - Fax:
Practice Address - Street 1:104 PRESTON ST
Practice Address - Street 2:1E
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-2500
Practice Address - Country:US
Practice Address - Phone:860-296-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN191781223G0001X
CT106991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice