Provider Demographics
NPI:1932647724
Name:SUNFLOWER FAMILY DENTAL PC
Entity Type:Organization
Organization Name:SUNFLOWER FAMILY DENTAL PC
Other - Org Name:SUNFLOWER FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-237-1865
Mailing Address - Street 1:1501 LOWER STATE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1216
Mailing Address - Country:US
Mailing Address - Phone:267-477-1711
Mailing Address - Fax:
Practice Address - Street 1:1501 LOWER STATE RD
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1216
Practice Address - Country:US
Practice Address - Phone:267-477-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031108L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty