Healthcare Provider Details

I. General information

NPI: 1841773785
Provider Name (Legal Business Name): SONAM SHETH DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 COOLEY ST
SPRINGFIELD MA
01128-1144
US

IV. Provider business mailing address

11 DOGWOOD DR
DANBURY CT
06811-4530
US

V. Phone/Fax

Practice location:
  • Phone: 413-796-1616
  • Fax:
Mailing address:
  • Phone: 203-715-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number060107
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12393
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: