Provider Demographics
NPI:1578299707
Name:YOUR DENTAL CONNECTION D.D.S., P.C.
Entity Type:Organization
Organization Name:YOUR DENTAL CONNECTION D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDOMIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-541-5161
Mailing Address - Street 1:26711 WOODWARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26711 WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1367
Practice Address - Country:US
Practice Address - Phone:248-541-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental