Healthcare Provider Details

I. General information

NPI: 1063580736
Provider Name (Legal Business Name): JOHN DAVID SOHONAGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

IV. Provider business mailing address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-1233
  • Fax:
Mailing address:
  • Phone: 302-855-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number951
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberGI-0001319
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: