Provider Demographics
NPI:1972647295
Name:SUD, AMIT (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:SUD
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 1:2879 W 95TH ST STE 131
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9008
Mailing Address - Country:US
Mailing Address - Phone:630-753-9955
Mailing Address - Fax:630-753-9966
Practice Address - Street 1:2879 W 95TH ST
Practice Address - Street 2:WOODLAKE FAMILY DENTAL SUITE 131
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-753-9955
Practice Address - Fax:630-753-9966
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice