MEDICARE: XI SUN DMD LLC

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	261QD0000X	Dental Clinic/Center	21890	MA

General Provider Information

NPI Number	:	1275903890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XI SUN DMD LLC

Provider Business Mailing Address
First Line	:	158 MAIN ST
Second Line	:
City	:	NORFOLK
State	:	MA
Zip	:	02056-1301
Country	:	US
Telephone Number	:	508-528-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 MAIN ST
Second Line	:
City	:	NORFOLK
State	:	MA
Zip	:	02056-1301
Country	:	US
Telephone Number	:	508-528-6510
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. XI SUN
Credential	:	DMD
Telephone Number	:	508-528-6510

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	09/25/2015

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