Healthcare Provider Details

I. General information

NPI: 1770399370
Provider Name (Legal Business Name): LITTLE SUNSHINE DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CEDAR LN STE 2
TEANECK NJ
07666-3442
US

IV. Provider business mailing address

315 CEDAR LN STE 2
TEANECK NJ
07666-3442
US

V. Phone/Fax

Practice location:
  • Phone: 201-357-5812
  • Fax: 201-357-5814
Mailing address:
  • Phone: 201-357-5812
  • Fax: 201-357-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NANCY CHUNG
Title or Position: BUSINESS OWNER
Credential:
Phone: 201-357-5812