Provider Demographics
NPI:1104949007
Name:SOOD, SACHIN (DMD)
Entity type:Individual
Prefix:DR
First Name:SACHIN
Middle Name:
Last Name:SOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3665
Mailing Address - Country:US
Mailing Address - Phone:516-280-9000
Mailing Address - Fax:
Practice Address - Street 1:701 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3665
Practice Address - Country:US
Practice Address - Phone:516-280-9000
Practice Address - Fax:516-280-8999
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist