Ksenia Sundukova, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1860063 Issued in MA

Practice address

30 College Ave
Somerville, MA 02144-1914

Phone

(617) 764-2247

NPI assigned

Mar 6, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1891495164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 STOCKTON ST APT 201",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "021502259",
            "telephone_number": "347-320-5653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 COLLEGE AVE",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021441914",
            "telephone_number": "617-764-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDUKOVA",
        "first_name": "KSENIA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-06",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1860063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trisha Sullivan, CLMT
• Anthony Sullo
• Penelope Summerall
• John Summersby
• Meera Sunder, MD
• Supportive Minds, PLLC
• Darcey L Surette, LMFT
• Stephanie Surma, PHARMD
• Rebecca Suschitzky, LCSW
• Andrea Svartstrom

• General Practice Dentistry in Somerville, MA
• Providers in Somerville, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.