Provider Demographics
NPI:1336256163
Name:SUNDAHL, CRAIG O (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:O
Last Name:SUNDAHL
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 1:26 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1109
Mailing Address - Country:US
Mailing Address - Phone:914-698-1882
Mailing Address - Fax:914-698-4566
Practice Address - Street 1:1 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1929
Practice Address - Country:US
Practice Address - Phone:914-833-1111
Practice Address - Fax:914-833-1274
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0233841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice