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NPI Code Detail

MEDICARE: DR. PAUL T SUGIYAMA DDS

MEDICARE: DR. PAUL T SUGIYAMA DDS
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
11223G0001XGeneral Practice Dentistry11351MI

General Provider Information

NPI Number : 1518188911
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL T SUGIYAMA DDS
Provider Business Mailing Address
First Line : 2013 EASTCASTLE DR SE
Second Line : SUITE A
City : GRAND RAPIDS
State : MI
Zip : 49508-8873
Country : US
Telephone Number : 616-281-3210
Fax Number :
Provider Business Practice Location Address
First Line : 2013 EASTCASTLE DR SE
Second Line : SUITE A
City : GRAND RAPIDS
State : MI
Zip : 49508-8873
Country : US
Telephone Number : 616-281-3210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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