Provider Demographics
NPI:1194533349
Name:SUNNY DENTAL SPA LLC
Entity type:Organization
Organization Name:SUNNY DENTAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNY
Authorized Official - Middle Name:MICHELINE
Authorized Official - Last Name:CLEMENTINO DE SA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-525-0224
Mailing Address - Street 1:9073 ARTISAN WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-2503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6305 INITIATIVE BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-1382
Practice Address - Country:US
Practice Address - Phone:919-525-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty