Provider Demographics
NPI:1083025019
Name:SUNSHINE SMILES
Entity Type:Organization
Organization Name:SUNSHINE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:CAVANAH
Authorized Official - Last Name:MIRDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-622-6255
Mailing Address - Street 1:8061 SPYGLASS HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8297
Mailing Address - Country:US
Mailing Address - Phone:321-622-6255
Mailing Address - Fax:321-622-6254
Practice Address - Street 1:8061 SPYGLASS HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8297
Practice Address - Country:US
Practice Address - Phone:321-622-6255
Practice Address - Fax:321-622-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty