Provider Demographics
NPI:1326564725
Name:SUNRISE ORTHODONTICS LLC
Entity Type:Organization
Organization Name:SUNRISE ORTHODONTICS LLC
Other - Org Name:SUNRISE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MDS
Authorized Official - Phone:702-645-5100
Mailing Address - Street 1:7090 N DURANGO DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4495
Mailing Address - Country:US
Mailing Address - Phone:702-645-5100
Mailing Address - Fax:702-645-6793
Practice Address - Street 1:3196 S MARYLAND PKWY STE 307
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2314
Practice Address - Country:US
Practice Address - Phone:702-629-5695
Practice Address - Fax:702-645-6793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIAN CHAMBERLAIN UNLIMITED, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty