Provider Demographics
NPI:1023556941
Name:WILLOUGHBY-MCDERMOTT, SUNNY MORGEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:MORGEN
Last Name:WILLOUGHBY-MCDERMOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CHIMNEY RDG
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-4103
Mailing Address - Country:US
Mailing Address - Phone:615-364-3036
Mailing Address - Fax:
Practice Address - Street 1:5300 HICKORY HOLLOW LN STE 107
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5083
Practice Address - Country:US
Practice Address - Phone:615-340-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-11
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122371223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program