Healthcare Provider Details

I. General information

NPI: 1881084234
Provider Name (Legal Business Name): SUNDUS MAROGY HY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 17 MILE RD
STERLING HEIGHTS MI
48310-6834
US

IV. Provider business mailing address

3939 17 MILE RD
STERLING HEIGHTS MI
48310-6834
US

V. Phone/Fax

Practice location:
  • Phone: 586-264-4240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: SUNDUS MAROGY
Title or Position: DDS/OWNER
Credential: DDS
Phone: 586-264-4240