Healthcare Provider Details

I. General information

NPI: 1124802434
Provider Name (Legal Business Name): SONJA CHESNUTT GIORDANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LINCOLN STREET 2ND FLOOR
TACOMA WA
98431-2210
US

IV. Provider business mailing address

1400 DEFENSE PENTAGON
WASHINGTON DC
20301-1400
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4079
  • Fax:
Mailing address:
  • Phone: 703-692-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS111373
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14040775-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: