Healthcare Provider Details

I. General information

NPI: 1174193163
Provider Name (Legal Business Name): SUNNY SMILES DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 57TH ST
BROOKLYN NY
11220-3645
US

IV. Provider business mailing address

2419 E 17TH ST
BROOKLYN NY
11235-3523
US

V. Phone/Fax

Practice location:
  • Phone: 718-686-0313
  • Fax: 718-686-0210
Mailing address:
  • Phone: 917-740-3883
  • 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: DR. SUNNY CHAN
Title or Position: OWNER
Credential: DDS
Phone: 917-740-3883