Provider Demographics
NPI:1962170100
Name:SUNNYVALE KIDS DDS PLLC
Entity type:Organization
Organization Name:SUNNYVALE KIDS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARCUP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-709-4225
Mailing Address - Street 1:274 S COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4625
Mailing Address - Country:US
Mailing Address - Phone:972-329-5437
Mailing Address - Fax:
Practice Address - Street 1:274 S COLLINS RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4625
Practice Address - Country:US
Practice Address - Phone:972-329-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty