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General NPI Number Information
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NPI Number | 1275806606
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Entity Type | Organization
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Legal Business Name | SUNSHINE DENTAL HOUSE PC
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 731 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11218-4306
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Country | US
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Telephone | 718-339-7773
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Fax | 718-339-7779
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Provider Business Mailing Address
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Address Line | 731 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11218-4306
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Country | US
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Telephone | 718-339-7773
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Fax | 718-339-7779
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Authorized Official
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Title or Position | MANGER
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Name | DAIVID HASBANI
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Credential | DDS
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Telephone | 718-339-7773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 047902
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License Number State | NY
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