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General NPI Number Information
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NPI Number | 1114034865
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Entity Type | Organization
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Legal Business Name | CRAIG O. SUNDAHL, D.D.S., P.C.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 MADISON AVE
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City | LARCHMONT
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State | NY
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Zip | 10538-1929
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Country | US
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Telephone | 914-833-1111
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Fax | 914-833-1274
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Provider Business Mailing Address
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Address Line | 26 COUNTRY RD
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City | MAMARONECK
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State | NY
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Zip | 10543-1109
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Country | US
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Telephone | 914-698-1882
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Fax | 914-698-4566
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAIG O. SUNDAHL
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Credential | D.D.S.
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Telephone | 914-833-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 023384
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License Number State | NY
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