Provider Demographics
NPI:1215453212
Name:MAGRUDER, SONIA HENRIQUEZ (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:HENRIQUEZ
Last Name:MAGRUDER
Suffix:
Gender:F
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 CLEAR LAKE CITY BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062
Mailing Address - Country:US
Mailing Address - Phone:281-691-0314
Mailing Address - Fax:
Practice Address - Street 1:1616 CLEAR LAKE CITY BLVD STE 108
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062
Practice Address - Country:US
Practice Address - Phone:281-486-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31155122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist