MEDICARE: ALLAN CARL SUNDIN 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
1	122300000X	Dentist	0401004026	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4964	OTHER		DORAL DENTAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942285275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLAN CARL SUNDIN DDS

Provider Business Mailing Address
First Line	:	401 49TH ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-2416
Country	:	US
Telephone Number	:	757-428-1044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 LASKIN RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6079
Country	:	US
Telephone Number	:	757-425-1547
Fax Number	:	757-425-6603

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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