Provider Demographics
NPI:1063612117
Name:SUN, ANDREA C (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:C
Last Name:SUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 31ST ST
Mailing Address - Street 2:#36G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3403
Mailing Address - Country:US
Mailing Address - Phone:917-232-6148
Mailing Address - Fax:
Practice Address - Street 1:537 KEARNY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2713
Practice Address - Country:US
Practice Address - Phone:201-246-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023460001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice