Provider Demographics
NPI:1588676274
Name:SUDITU, MARIUS V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIUS
Middle Name:V
Last Name:SUDITU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:845-546-1114
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice