Provider Demographics
NPI:1649694696
Name:SUDACOV, VLAD (DMD)
Entity type:Individual
Prefix:DR
First Name:VLAD
Middle Name:
Last Name:SUDACOV
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 1:45 W 10TH ST APT LE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8727
Mailing Address - Country:US
Mailing Address - Phone:212-982-5883
Mailing Address - Fax:
Practice Address - Street 1:45 W 10TH ST APT LE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8727
Practice Address - Country:US
Practice Address - Phone:212-982-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02603700122300000X
NY057986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist