MEDICARE: SONALI RAMAN WAGH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	50394	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1336108604	OTHER	CA	GENERAL PRACTICE

General Provider Information

NPI Number	:	1336108604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONALI RAMAN WAGH DDS

Provider Business Mailing Address
First Line	:	1665 DIAMOND WOODS CIRCLE
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747
Country	:	US
Telephone Number	:	916-434-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 MARCONI AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3902
Country	:	US
Telephone Number	:	916-487-7995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	09/30/2014

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