Organization
SUNNYSIDE ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JASMINE CHRISTINE LEE (MANAGER)
(718) 433-2304
Entity
Organization
Contact information
Practice address
4312 43RD ST, SUNNYSIDE, NY 11104-2608
(718) 433-2304
Mailing address
4312 43RD ST, SUNNYSIDE, NY 11104-2608
(718) 433-2304
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0533131-8
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02860204
—
NY
Enumeration date
01/18/2013
Last updated
02/15/2013
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