Provider Demographics
NPI:1568505360
Name:SUNNYSIDE DENTAL, PC
Entity Type:Organization
Organization Name:SUNNYSIDE DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAPPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-706-1717
Mailing Address - Street 1:4701 QUEENS BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1600
Mailing Address - Country:US
Mailing Address - Phone:718-706-1717
Mailing Address - Fax:718-706-7477
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1600
Practice Address - Country:US
Practice Address - Phone:718-706-1717
Practice Address - Fax:718-706-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045521261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental