Provider Demographics
NPI:1336692995
Name:SUNLIGHT DENTAL GROUP PA
Entity Type:Organization
Organization Name:SUNLIGHT DENTAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:BA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-243-1740
Mailing Address - Street 1:1816 PEARLAND PKWY # 190
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5100
Mailing Address - Country:US
Mailing Address - Phone:832-243-1740
Mailing Address - Fax:832-288-4502
Practice Address - Street 1:1816 PEARLAND PKWY # 190
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5100
Practice Address - Country:US
Practice Address - Phone:832-243-1740
Practice Address - Fax:832-288-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty