Active NPI
Prachi Shridhar Sontakke, DMD
- Dentist
- Rock Hill, SC
National Provider Identifier
1124452636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8845
- Practice address
- 1505 Ebenezer Rd
Rock Hill, SC 29732-1806 - Phone
- (857) 413-0948
- NPI assigned
- Sep 3, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1856394 | MA | |
| Dentist | 122300000X | 8845 | SC | Primary |
Addresses
Primary practice location
1505 Ebenezer Rd
Rock Hill, SC 29732-1806
Mailing address
1505 Ebenezer Rd
Rock Hill, SC 29732-1806
Phone (857) 413-0948
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZX8845 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150702001790 | MA | Order and Referring Only - Oral Surgery | 6406168558 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8845 | SC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522195200000",
"number": "1124452636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 EBENEZER RD",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297321806",
"telephone_number": "857-413-0948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 EBENEZER RD",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297321806",
"telephone_number": "857-413-0948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONTAKKE",
"first_name": "PRACHI",
"middle_name": "SHRIDHAR",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-03",
"last_updated": "2018-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1856394",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "8845",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZX8845",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rock Hill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.