Individual
CHARLES SONSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
T61-92-8270
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
T61-92-8270
VA
305R00000X
Preferred Provider Organization
Primary
T61-92-8270
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UAL000180405
BLUECROSS BLUESHIELD
IL
Enumeration date
02/05/2009
Last updated
02/06/2009
Update your record
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