Provider Demographics
NPI:1114517851
Name:SONRISA DENTAL SPA LLC
Entity Type:Organization
Organization Name:SONRISA DENTAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-547-3232
Mailing Address - Street 1:915 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2791
Mailing Address - Country:US
Mailing Address - Phone:160-954-7323
Mailing Address - Fax:
Practice Address - Street 1:915 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2791
Practice Address - Country:US
Practice Address - Phone:609-547-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty