Healthcare Provider Details

I. General information

NPI: 1821992033
Provider Name (Legal Business Name): DR. SANJEEV SONI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

14414 FOUR CHIMNEY DR
CENTREVILLE VA
20120-3217
US

IV. Provider business mailing address

14414 FOUR CHIMNEY DR
CENTREVILLE VA
20120-3217
US

V. Phone/Fax

Practice location:
  • Phone: 703-686-0170
  • Fax:
Mailing address:
  • Phone: 703-686-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420326
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: