Provider Demographics
NPI:1528263886
Name:SUN, XI (DMD)
Entity type:Individual
Prefix:DR
First Name:XI
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 SUMMER ST
Mailing Address - Street 2:#9
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-9802
Mailing Address - Country:US
Mailing Address - Phone:781-641-4904
Mailing Address - Fax:
Practice Address - Street 1:725 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4902
Practice Address - Country:US
Practice Address - Phone:781-643-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice