Provider Demographics
NPI:1205027067
Name:SPINOSA, SUNNY JOHN COSMO (DDS)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:JOHN COSMO
Last Name:SPINOSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DOUBLEDAY CT
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1223
Mailing Address - Country:US
Mailing Address - Phone:607-547-2313
Mailing Address - Fax:
Practice Address - Street 1:6 DOUBLEDAY CT
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1223
Practice Address - Country:US
Practice Address - Phone:607-547-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054159-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist