Provider Demographics
NPI:1801781109
Name:SONAGRA, MAITRY
Entity type:Individual
Prefix:
First Name:MAITRY
Middle Name:
Last Name:SONAGRA
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 1:7550 ST PATRICK WAY APT 568
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4887
Mailing Address - Country:US
Mailing Address - Phone:717-982-9680
Mailing Address - Fax:
Practice Address - Street 1:2120 RAILROAD AVE STE 105
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4880
Practice Address - Country:US
Practice Address - Phone:717-982-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1115721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice