MEDICARE: PRUTHA SONI DDS

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	0401417301	VA
2	1223G0001X	General Practice Dentistry	37121	TX

General Provider Information

NPI Number	:	1306418389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRUTHA SONI DDS

Provider Business Mailing Address
First Line	:	49 PINECREST RD
Second Line	:
City	:	SOMERSET
State	:	NJ
Zip	:	08873-1666
Country	:	US
Telephone Number	:	330-741-0480
Fax Number	:

Provider Business Practice Location Address
First Line	:	3211 W NORTHWEST HWY # 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-5944
Country	:	US
Telephone Number	:	972-128-4320
Fax Number	:

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

Provider Enumeration Date	:	07/11/2021
Last Update Date	:	07/11/2021

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Directions to “ PRUTHA SONI DDS” Practice Location

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