Provider Demographics
NPI:1154910412
Name:SUN DENTAL SPECIALTY, LLC
Entity type:Organization
Organization Name:SUN DENTAL SPECIALTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRUKULLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-233-6672
Mailing Address - Street 1:7419 NEW FALLS RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19055-1008
Mailing Address - Country:US
Mailing Address - Phone:215-945-5199
Mailing Address - Fax:215-945-6290
Practice Address - Street 1:7419 NEW FALLS RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-1008
Practice Address - Country:US
Practice Address - Phone:215-945-5199
Practice Address - Fax:215-945-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty