MEDICARE: DR. AMEE SONI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1073668380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMEE SONI D.D.S.

Provider Business Mailing Address
First Line	:	5155 MADISON ST
Second Line	:	# 407
City	:	SKOKIE
State	:	IL
Zip	:	60077-5231
Country	:	US
Telephone Number	:	847-972-1428
Fax Number	:

Provider Business Practice Location Address
First Line	:	5539 W CERMAK RD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2218
Country	:	US
Telephone Number	:	708-652-7575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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