Provider Demographics
NPI:1568878478
Name:PARK, SUNNY (DMD)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:TURTLE CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15145-1318
Mailing Address - Country:US
Mailing Address - Phone:412-824-6888
Mailing Address - Fax:412-766-0262
Practice Address - Street 1:3808 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-1676
Practice Address - Country:US
Practice Address - Phone:412-766-3100
Practice Address - Fax:412-766-0262
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist