Healthcare Provider Details

I. General information

NPI: 1235050949
Provider Name (Legal Business Name): SWEET TOOTH DENTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21339 40TH AVE
BAYSIDE NY
11361-2046
US

IV. Provider business mailing address

21339 40TH AVE
BAYSIDE NY
11361-2046
US

V. Phone/Fax

Practice location:
  • Phone: 718-489-8809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JI HYAE PARK
Title or Position: PRESIDENT
Credential: DDS
Phone: 917-575-4535