Provider Demographics
NPI:1245777200
Name:SUNNYMEAD RANCH DENTAL CENTER
Entity Type:Organization
Organization Name:SUNNYMEAD RANCH DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-242-8282
Mailing Address - Street 1:23569 SUNNYMEAD RANCH PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557
Mailing Address - Country:US
Mailing Address - Phone:951-242-8282
Mailing Address - Fax:
Practice Address - Street 1:23569 SUNNYMEAD RANCH PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-2884
Practice Address - Country:US
Practice Address - Phone:951-242-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty