Provider Demographics
NPI:1275919870
Name:SUNRISE PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:SUNRISE PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:CRESPI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-660-2467
Mailing Address - Street 1:3650 E. 1ST AVENUE
Mailing Address - Street 2:STE. 301
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5507
Mailing Address - Country:US
Mailing Address - Phone:720-660-2467
Mailing Address - Fax:206-312-2950
Practice Address - Street 1:3650 E 1ST AVE
Practice Address - Street 2:STE. 301
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5500
Practice Address - Country:US
Practice Address - Phone:720-660-2467
Practice Address - Fax:206-312-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10769261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental