Provider Demographics
NPI:1154989960
Name:SUNDE, JUHWA (DMD)
Entity type:Individual
Prefix:
First Name:JUHWA
Middle Name:
Last Name:SUNDE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:SUNDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1310 S ROCK ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7160
Mailing Address - Country:US
Mailing Address - Phone:870-942-2822
Mailing Address - Fax:
Practice Address - Street 1:1310 S ROCK ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7160
Practice Address - Country:US
Practice Address - Phone:870-942-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist