Provider Demographics
NPI:1770135048
Name:KUNTHARA, SONIA JACOB (DDS)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:JACOB
Last Name:KUNTHARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 S COLUMBUS CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0326
Mailing Address - Country:US
Mailing Address - Phone:602-369-2178
Mailing Address - Fax:
Practice Address - Street 1:633 E RAY RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4202
Practice Address - Country:US
Practice Address - Phone:480-833-0880
Practice Address - Fax:480-833-0225
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0104331223G0001X
TX370151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice