Provider Demographics
NPI:1306182019
Name:SUNRISE DENTAL HENDERSON LLC
Entity Type:Organization
Organization Name:SUNRISE DENTAL HENDERSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHING KUO TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-270-8880
Mailing Address - Street 1:1550 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE S
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3600
Mailing Address - Country:US
Mailing Address - Phone:702-270-8880
Mailing Address - Fax:702-270-8886
Practice Address - Street 1:1550 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE S
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3600
Practice Address - Country:US
Practice Address - Phone:702-270-8880
Practice Address - Fax:702-270-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV34801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty