Provider Demographics
NPI:1376621672
Name:SUNSHINE ORTHODONTICS
Entity Type:Organization
Organization Name:SUNSHINE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-237-1982
Mailing Address - Street 1:825 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3337
Mailing Address - Country:US
Mailing Address - Phone:813-237-1982
Mailing Address - Fax:813-232-0744
Practice Address - Street 1:825 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3337
Practice Address - Country:US
Practice Address - Phone:813-237-1982
Practice Address - Fax:813-232-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty