Provider Demographics
NPI:1801970827
Name:SONNE, MARVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:SONNE
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 1:28601 APPLEBLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2403
Mailing Address - Country:US
Mailing Address - Phone:248-553-2958
Mailing Address - Fax:
Practice Address - Street 1:1550 KINGSWAY CT
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1923
Practice Address - Country:US
Practice Address - Phone:734-671-8414
Practice Address - Fax:734-671-8234
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010104861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1766417Medicaid