Provider Demographics
NPI:1043069289
Name:SONDERLING, EZRA (DMD)
Entity type:Individual
Prefix:DR
First Name:EZRA
Middle Name:
Last Name:SONDERLING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 MASSACHUSETTS AVE STE 2-6
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3072
Mailing Address - Country:US
Mailing Address - Phone:617-800-7533
Mailing Address - Fax:
Practice Address - Street 1:872 MASSACHUSETTS AVE STE 2-6
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3072
Practice Address - Country:US
Practice Address - Phone:617-574-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN100002771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice