Provider Demographics
NPI:1144775149
Name:TILWANI, SUNNY K
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:K
Last Name:TILWANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 W. 15TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:972-867-3900
Mailing Address - Fax:972-964-2263
Practice Address - Street 1:3804 W. 15TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:972-867-3900
Practice Address - Fax:972-964-2263
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL13013122300000X, 1223P0300X
IL1360002471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentist