Provider Demographics
NPI:1114262227
Name:MARIUS V SUDITU DDS PC
Entity Type:Organization
Organization Name:MARIUS V SUDITU DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDITU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-632-6613
Mailing Address - Street 1:1289 ROUTE 9
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4992
Mailing Address - Country:US
Mailing Address - Phone:845-632-6613
Mailing Address - Fax:845-632-6614
Practice Address - Street 1:1289 ROUTE 9
Practice Address - Street 2:SUITE 8
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4992
Practice Address - Country:US
Practice Address - Phone:845-632-6613
Practice Address - Fax:845-632-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty