Provider Demographics
NPI:1871647933
Name:SATA, KUNDAN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:KUNDAN
Middle Name:B
Last Name:SATA
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 1:10000 WAYNE RD
Mailing Address - Street 2:102
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3445
Mailing Address - Country:US
Mailing Address - Phone:734-942-0560
Mailing Address - Fax:734-942-5955
Practice Address - Street 1:10000 WAYNE RD
Practice Address - Street 2:102
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-3445
Practice Address - Country:US
Practice Address - Phone:734-942-0560
Practice Address - Fax:734-942-5955
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1056901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice