Basic Information
| Provider Information | |||||||||
| NPI: | 1750644647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOOD | ||||||||
| FirstName: | AMIT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D, M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606793004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 346 MAIN AVE STE H | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068511592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039399390 | ||||||||
| FaxNumber: | 2039399391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2012 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 12318 | CT | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.