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General NPI Number Information
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NPI Number | 1619014560
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Entity Type | Organization
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Legal Business Name | SONJA L. MAGGARD, DMD, PSC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 121 PROSPEROUS PL SUITE 12B
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City | LEXINGTON
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State | KY
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Zip | 40509-1800
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Country | US
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Telephone | 859-263-1888
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Fax | 859-263-1888
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Provider Business Mailing Address
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Address Line | 121 PROSPEROUS PL SUITE 12B
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City | LEXINGTON
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State | KY
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Zip | 40509-1800
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Country | US
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Telephone | 859-263-1888
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Fax | 859-263-1888
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Authorized Official
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Title or Position | OWNER
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Name | DR. SONJA L MAGGARD
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Credential | DMD
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Telephone | 859-263-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6881
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License Number State | KY
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