Provider Demographics
NPI:1609958198
Name:SUNDHEIMER, RICHARD NEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEIL
Last Name:SUNDHEIMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4181 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2531
Mailing Address - Country:US
Mailing Address - Phone:330-493-1605
Mailing Address - Fax:330-493-9308
Practice Address - Street 1:4181 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2531
Practice Address - Country:US
Practice Address - Phone:330-493-1605
Practice Address - Fax:330-493-9308
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0188931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0733255Medicaid
OH0733255Medicaid
OHSU0697613Medicare ID - Type Unspecified
OHU19505Medicare UPIN