1619450947 NPI number — SUNSTAR DENTAL, P. C.

Table of content: LINDSEY D. CAUDLE RN (NPI 1780881243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619450947 NPI number — SUNSTAR DENTAL, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSTAR DENTAL, P. C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619450947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3724 PARSONS BLVD FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11354-5830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
929-200-7789
Provider Business Mailing Address Fax Number:
929-200-7790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3724 PARSONS BLVD FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-5830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-200-7789
Provider Business Practice Location Address Fax Number:
929-200-7790
Provider Enumeration Date:
09/12/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUANG
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
929-200-7789

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)