MEDICARE: DR. SUNIL K SINGH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN014527	GA

General Provider Information

NPI Number	:	1053402313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNIL K SINGH DMD

Provider Business Mailing Address
First Line	:	175 WHITE ST NW STE 300
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7901
Country	:	US
Telephone Number	:	770-422-6521
Fax Number	:	317-721-7662

Provider Business Practice Location Address
First Line	:	1103 GABLES DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-4190
Country	:	US
Telephone Number	:	317-721-7662
Fax Number	:	317-721-7662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/22/2020

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