Healthcare Provider Details

I. General information

NPI: 1336060979
Provider Name (Legal Business Name): TULSI SONI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 GREAT OAK CT
FORT WAYNE IN
46825-1820
US

IV. Provider business mailing address

44 N SAVANNAH PKWY
ROUND LAKE IL
60073-9579
US

V. Phone/Fax

Practice location:
  • Phone: 260-490-3495
  • Fax:
Mailing address:
  • Phone: 224-730-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12015097A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: