Provider Demographics
NPI:1912443110
Name:JESSAMINE T. SUNGLAO DDS INC
Entity Type:Organization
Organization Name:JESSAMINE T. SUNGLAO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSAMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNGLAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-469-0494
Mailing Address - Street 1:7900 EL CAJON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0655
Mailing Address - Country:US
Mailing Address - Phone:619-469-0494
Mailing Address - Fax:
Practice Address - Street 1:7900 EL CAJON BLVD STE D
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0655
Practice Address - Country:US
Practice Address - Phone:619-469-0494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty