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General NPI Number Information
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NPI Number | 1811758824
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Entity Type | Individual
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Provider Name | JIABAO SUN DMD, MDS
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Gender | Female
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 02/10/2024
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Provider Practice Location Address
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Address Line | 5964 S STATE ROUTE 48
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City | MAINEVILLE
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State | OH
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Zip | 45039-8845
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Country | US
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Telephone | 513-239-8104
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Fax |
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Provider Business Mailing Address
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Address Line | 3718 NANTUCKET DR
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City | LOVELAND
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State | OH
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Zip | 45140-3612
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30026186
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 220543813
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License Number State | PA
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