Healthcare Provider Details

I. General information

NPI: 1154731669
Provider Name (Legal Business Name): CEDAR POINT FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 N SANDUSKY RD
SANDUSKY MI
48471-9143
US

IV. Provider business mailing address

749 N SANDUSKY RD
SANDUSKY MI
48471-9143
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-3224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017882
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY BURDUA
Title or Position: MANAGING DOCTOR
Credential: DDS
Phone: 810-648-3224