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NPI Code Detail

MEDICARE: GAURAV SOOD

MEDICARE: GAURAV SOOD
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
11223G0001XGeneral Practice Dentistry6001856-15WI

General Provider Information

NPI Number : 1538057377
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAURAV SOOD
Provider Business Mailing Address
First Line : 1551 PARK PL STE 300
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-1969
Country : US
Telephone Number : 920-365-5365
Fax Number :
Provider Business Practice Location Address
First Line : 1551 PARK PL STE 300
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-1969
Country : US
Telephone Number : 920-365-5365
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2025
Last Update Date : 06/27/2025

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Directions to “ GAURAV SOOD ” Practice Location

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