Provider Demographics
NPI:1083496434
Name:SUNRISE DENTAL INC
Entity Type:Organization
Organization Name:SUNRISE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-233-3958
Mailing Address - Street 1:1133 WAIMANU ST APT 609
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4251
Mailing Address - Country:US
Mailing Address - Phone:626-233-3959
Mailing Address - Fax:
Practice Address - Street 1:99-902 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3252
Practice Address - Country:US
Practice Address - Phone:626-233-3958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty