Provider Demographics
NPI:1053431411
Name:KORATKAR, SONAL M (DDS)
Entity type:Individual
Prefix:DR
First Name:SONAL
Middle Name:M
Last Name:KORATKAR
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 1:2220 RIVERSIDE AVE
Mailing Address - Street 2:HEALTHPARTNERS RIVERSIDE DENTAL CLINIC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1321
Mailing Address - Country:US
Mailing Address - Phone:612-341-1400
Mailing Address - Fax:612-341-1401
Practice Address - Street 1:2220 RIVERSIDE AVE
Practice Address - Street 2:HEALTHPARTNERS RIVERSIDE DENTAL CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:218-263-8381
Practice Address - Fax:218-263-8383
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND119101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN91056KOOtherBLUE CROSS BLUE SHIELD
MN913172800OtherMN HEALTH CARE PROVIDER