Healthcare Provider Details

I. General information

NPI: 1851657142
Provider Name (Legal Business Name): CRAIG BRENDAN SONNEVELD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 COOL SPRINGS BLVD SUITE 140
FRANKLIN TN
37067-6474
US

IV. Provider business mailing address

14200 WOODWARD DR
ORLAND PARK IL
60462-2321
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-1111
  • Fax:
Mailing address:
  • Phone: 708-403-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10176
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: