Provider Demographics
NPI:1356028088
Name:SONI, SUMIT (DDS)
Entity type:Individual
Prefix:DR
First Name:SUMIT
Middle Name:
Last Name:SONI
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 1:200 BOARDWALK AVE APT 122
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6021
Mailing Address - Country:US
Mailing Address - Phone:902-989-0293
Mailing Address - Fax:
Practice Address - Street 1:2525 HOWELL BRANCH RD STE 1051
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6574
Practice Address - Country:US
Practice Address - Phone:321-972-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL282851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice