Provider Demographics
NPI:1780896613
Name:DIVNEY, SONIA CONTANZA (DDSMS)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:CONTANZA
Last Name:DIVNEY
Suffix:
Gender:F
Credentials:DDSMS
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:BUSTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:269 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1314
Mailing Address - Country:US
Mailing Address - Phone:781-581-3900
Mailing Address - Fax:781-596-3966
Practice Address - Street 1:232 UNION ST.
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901
Practice Address - Country:US
Practice Address - Phone:781-581-9832
Practice Address - Fax:781-581-9583
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA89731223P0300X
MACERT. NO. 10466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics