Provider Demographics
NPI:1417220070
Name:SUNSET DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:SUNSET DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-656-5900
Mailing Address - Street 1:929 W SUNSET BLVD
Mailing Address - Street 2:STE. 15
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4865
Mailing Address - Country:US
Mailing Address - Phone:435-656-5900
Mailing Address - Fax:435-656-4830
Practice Address - Street 1:929 W SUNSET BLVD
Practice Address - Street 2:STE. 15
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4865
Practice Address - Country:US
Practice Address - Phone:435-656-5900
Practice Address - Fax:435-656-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4919293-99221223G0001X
UT13805699221223G0001X
UT341178-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty