Healthcare Provider Details

I. General information

NPI: 1649779034
Provider Name (Legal Business Name): SANDUSKY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

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