Provider Demographics
NPI:1447702071
Name:SONDRA L AVANT DDS MS PA
Entity type:Organization
Organization Name:SONDRA L AVANT DDS MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:386-304-4620
Mailing Address - Street 1:731 DUNLAWTON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4237
Mailing Address - Country:US
Mailing Address - Phone:386-304-4620
Mailing Address - Fax:386-304-4619
Practice Address - Street 1:731 DUNLAWTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4237
Practice Address - Country:US
Practice Address - Phone:386-304-4620
Practice Address - Fax:386-304-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN136061223E0200X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty