Basic Information
| Provider Information | |||||||||
| NPI: | 1609417005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUNNY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | BETH KURUVILLA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KURUVILLA | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | BETH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4802 LAKE VIEW PKWY | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724025789 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4802 LAKEVIEW PKWY | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724025789 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2019 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DS042449 | PA | N | Dental Providers | Dentist | General Practice | 1223G0001X | DD5216 | NM | N | Dental Providers | Dentist | General Practice | 1223G0001X | 36631 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.