Individual
SONIYA SALIL VASANWALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
890 RICHARD RD STE B, DYER, IN 46311-1780
(815) 735-4963
Mailing address
3540 TOULOUSE, BOURBONNAIS, IL 60914-4558
(815) 735-4963
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.031581
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019.031581
STATE OF ILLINOIS
IL
Enumeration date
07/26/2018
Last updated
07/26/2018
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