Provider Demographics
NPI:1740934058
Name:SUN, JESSICA NIANCI (DMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NIANCI
Last Name:SUN
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 1:11828 RING DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-2106
Mailing Address - Country:US
Mailing Address - Phone:512-640-5435
Mailing Address - Fax:
Practice Address - Street 1:11828 RING DR STE 102
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-2106
Practice Address - Country:US
Practice Address - Phone:151-264-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX401271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice