Provider Demographics
NPI:1619191376
Name:SUNSERI, RICHARD MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:SUNSERI
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 1:511 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-1305
Mailing Address - Country:US
Mailing Address - Phone:814-886-8105
Mailing Address - Fax:
Practice Address - Street 1:511 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GALLITZIN
Practice Address - State:PA
Practice Address - Zip Code:16641-1305
Practice Address - Country:US
Practice Address - Phone:814-886-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021109-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice