# COUNTRY CLUB DENTAL, INC. / DBA: SUNNY SMILE DENTAL, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427897701
- **Authorized official:** DR. SANEAL NARENDRA MISTRY DDS (OWNER)
- **Authorized official phone:** (505) 850-6700

## Contact information

- **Practice address:** 317 W COUNTRY CLUB RD, ROSWELL, NM 88201-5892
- **Practice address phone:** (505) 850-6700
- **Mailing address:** 9 CHARING CROSS CT, ROSWELL, NM 88201-0408
- **Mailing address phone:** (505) 850-6700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/24/2024
- **Last updated:** 05/24/2024