Provider Demographics
NPI:1053140475
Name:SURESH SAPARE, SONALI
Entity type:Individual
Prefix:
First Name:SONALI
Middle Name:
Last Name:SURESH SAPARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14925 CORDERO DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4537
Mailing Address - Country:US
Mailing Address - Phone:919-274-7299
Mailing Address - Fax:
Practice Address - Street 1:110 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2627
Practice Address - Country:US
Practice Address - Phone:979-968-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX402981223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics