Provider Demographics
NPI:1891909081
Name:SUNGLAO, JESSAMINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSAMINE
Middle Name:
Last Name:SUNGLAO
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 1:3903 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2614
Mailing Address - Country:US
Mailing Address - Phone:562-427-2478
Mailing Address - Fax:562-981-9258
Practice Address - Street 1:3903 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2614
Practice Address - Country:US
Practice Address - Phone:562-427-2478
Practice Address - Fax:562-981-9258
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice