MEDICARE: MS. ERIN RENE SUNDT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901020597	MI

General Provider Information

NPI Number	:	1487805073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN RENE SUNDT DDS

Provider Business Mailing Address
First Line	:	3485 AIRPORT RD # MI48329
Second Line	:
City	:	WATERFORD TOWNSHIP
State	:	MI
Zip	:	48329-3017
Country	:	US
Telephone Number	:	248-623-7722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3485 AIRPORT RD # MI48329
Second Line	:
City	:	WATERFORD TOWNSHIP
State	:	MI
Zip	:	48329-3017
Country	:	US
Telephone Number	:	248-623-7722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	07/10/2023

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