Healthcare Provider Details

I. General information

NPI: 1679323778
Provider Name (Legal Business Name): KAHANI SONI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10930 CRABAPPLE RD STE 106
ROSWELL GA
30075-5825
US

IV. Provider business mailing address

3221 WHITNEY RD
AURORA IL
60502-7060
US

V. Phone/Fax

Practice location:
  • Phone: 678-352-1090
  • Fax:
Mailing address:
  • Phone: 630-962-1953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN124234
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: