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General NPI Number Information
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NPI Number | 1003612730
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Entity Type | Organization
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Legal Business Name | LITTLE LOVE PEDIATRIC DENTISTRY AND WELLNESS
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 50 SILVER FOREST DR STE 108
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3836
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Country | US
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Telephone | 904-206-8809
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Fax |
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Provider Business Mailing Address
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Address Line | 628 SOUTHERN OAK DR
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32081-8368
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Country | US
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Telephone | 904-206-8809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMBER SUN
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Credential |
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Telephone | 404-578-5247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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