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General NPI Number Information
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NPI Number | 1194533349
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Entity Type | Organization
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Legal Business Name | SUNNY DENTAL SPA LLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 6305 INITIATIVE BLVD
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City | SARASOTA
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State | FL
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Zip | 34240-1382
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Country | US
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Telephone | 919-525-0224
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Fax |
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Provider Business Mailing Address
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Address Line | 9073 ARTISAN WAY
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City | SARASOTA
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State | FL
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Zip | 34240-2503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ANNY MICHELINE CLEMENTINO DE SA
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Credential | DDS
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Telephone | 919-525-0224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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