MEDICARE: SUNDUS MAROGY HY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223G0001X	General Practice Dentistry
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
4	124Q00000X	Dental Hygienist
5	122300000X	Dentist

General Provider Information

NPI Number	:	1881084234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNDUS MAROGY HY LLC

Provider Business Mailing Address
First Line	:	3939 17 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 17 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6834
Country	:	US
Telephone Number	:	586-264-4240
Fax Number	:

Authorized Official
Title or Position	:	DDS/OWNER
Name	:	SUNDUS MAROGY
Credential	:	DDS
Telephone Number	:	586-264-4240

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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