Healthcare Provider Details

I. General information

NPI: 1720655384
Provider Name (Legal Business Name): NISHA SONI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S69W15466 JANESVILLE RD
MUSKEGO WI
53150-9330
US

IV. Provider business mailing address

5245 MARDJETKO DR
HOFFMAN ESTATES IL
60192-4139
US

V. Phone/Fax

Practice location:
  • Phone: 414-253-6369
  • Fax:
Mailing address:
  • Phone: 630-999-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1002660
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: