Healthcare Provider Details

I. General information

NPI: 1821745506
Provider Name (Legal Business Name): PRATEEK SOOD BRAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 ZINFANDEL DR STE B1
RANCHO CORDOVA CA
95670-4265
US

IV. Provider business mailing address

1871 PETITE SYRAH LN
ROSEVILLE CA
95747-6684
US

V. Phone/Fax

Practice location:
  • Phone: 916-638-9832
  • Fax:
Mailing address:
  • Phone: 209-617-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: