Healthcare Provider Details

I. General information

NPI: 1104661115
Provider Name (Legal Business Name): SONYA MARIA DOUGLAS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 6TH ST
BREMERTON WA
98337-1420
US

IV. Provider business mailing address

703 SHERIDAN RD UNIT B
BREMERTON WA
98310-2539
US

V. Phone/Fax

Practice location:
  • Phone: 360-377-3776
  • Fax:
Mailing address:
  • Phone: 339-225-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number70157014
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: