Michael Sundberg, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3644 Issued in ME

Practice address

1006 Forest Ave
Portland Family Dental
Portland, ME 04103-3343

Phone

(207) 797-3585

Fax

(207) 797-3592

NPI assigned

Mar 5, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 6, 2016 through Apr 6, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Portland Family Dental

  • Dentist
  • Portland, ME
  • NPI 1437362779
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699804880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 FOREST AVE",
            "address_2": "PORTLAND FAMILY DENTAL",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041033343",
            "telephone_number": "207-797-3585",
            "fax_number": "207-797-3592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 FOREST AVE",
            "address_2": "PORTLAND FAMILY DENTAL",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041033343",
            "telephone_number": "207-797-3585",
            "fax_number": "207-797-3592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDBERG",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "3644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael P Sullivan, MD
• William M Sullivan, M.D.
• Jennie S Summers-Shea, LCPC
• Sun Valley Plus LLC
• Ningyuan Sun
• Kaiya Mare' Sundeen
• Karen Joan Sundqvist, M.A., CCC-SLP
• Mary Beth H Sunenblick, LCSW
• Sunrise Home Care of Maine LLC
• Sunshine Home Care LLC

• General Practice Dentistry in Portland, ME
• Providers in Portland, ME by specialty
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.