Provider Demographics
NPI:1598835399
Name:SUDOMIR, RONALD LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LOUIS
Last Name:SUDOMIR
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 1:1147 E LONG LAKE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4943
Mailing Address - Country:US
Mailing Address - Phone:248-524-1280
Mailing Address - Fax:248-524-1254
Practice Address - Street 1:1147 E LONG LAKE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4943
Practice Address - Country:US
Practice Address - Phone:248-524-1280
Practice Address - Fax:248-524-1254
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist