Provider Demographics
NPI:1104077429
Name:MATHEW, SOGINI MARIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:SOGINI
Middle Name:MARIAM
Last Name:MATHEW
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 1:1128 NICK CIR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3353
Mailing Address - Country:US
Mailing Address - Phone:516-477-7208
Mailing Address - Fax:
Practice Address - Street 1:2100 HEDGCOXE RD STE 170
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025
Practice Address - Country:US
Practice Address - Phone:972-517-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054061-11223G0001X
TX273401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice