Provider Demographics
NPI:1467566539
Name:SUN, AMY (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SUN
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:VAMC--OVERTON BROOKS DENTAL SERVICES
Mailing Address - Street 2:510 EAST STONER AVE
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4295
Mailing Address - Country:US
Mailing Address - Phone:318-424-6009
Mailing Address - Fax:
Practice Address - Street 1:510 EAST STONER AVE
Practice Address - Street 2:DENTAL SERVICES
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4295
Practice Address - Country:US
Practice Address - Phone:318-424-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050700-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice