Provider Demographics
NPI:1407677685
Name:SUNFLOWER DENTAL GROUP PC
Entity type:Organization
Organization Name:SUNFLOWER DENTAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHANSOUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-488-1164
Mailing Address - Street 1:265 CEDAR LN
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3444
Mailing Address - Country:US
Mailing Address - Phone:201-488-1164
Mailing Address - Fax:
Practice Address - Street 1:265 CEDAR LN STE 203
Practice Address - Street 2:FLOOR 3
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3444
Practice Address - Country:US
Practice Address - Phone:201-488-1164
Practice Address - Fax:201-488-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty