Provider Demographics
NPI:1598820102
Name:SUNG, ANITA MAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:MAY
Last Name:SUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 PARKLAWN DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:410-535-1990
Mailing Address - Fax:410-535-9649
Practice Address - Street 1:1522 POINTER RIDGE PLACE
Practice Address - Street 2:SUITE E
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-249-1102
Practice Address - Fax:301-249-3258
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5318122300000X, 1223G0001X
MD10740122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC097787700OtherDC ACS
MD544135981Medicaid