Healthcare Provider Details

I. General information

NPI: 1124452636
Provider Name (Legal Business Name): PRACHI SHRIDHAR SONTAKKE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EBENEZER RD
ROCK HILL SC
29732-1806
US

IV. Provider business mailing address

1505 EBENEZER RD
ROCK HILL SC
29732-1806
US

V. Phone/Fax

Practice location:
  • Phone: 857-413-0948
  • Fax:
Mailing address:
  • Phone: 857-413-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856394
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8845
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: