Healthcare Provider Details

I. General information

NPI: 1184903486
Provider Name (Legal Business Name): GEOFFREY N SUDIT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 W 43RD ST
MINNEAPOLIS MN
55410-1536
US

IV. Provider business mailing address

2804 W 43RD ST
MINNEAPOLIS MN
55410-1536
US

V. Phone/Fax

Practice location:
  • Phone: 612-509-6468
  • Fax:
Mailing address:
  • Phone: 612-509-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12941
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD12941
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: