Provider Demographics
NPI:1457511388
Name:SUNSHINEDENTALGROUPOF JORGEANGEL VILLASENORDDSDENTALCORP
Entity Type:Organization
Organization Name:SUNSHINEDENTALGROUPOF JORGEANGEL VILLASENORDDSDENTALCORP
Other - Org Name:SUNSHINE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-579-4274
Mailing Address - Street 1:4161 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1966
Mailing Address - Country:US
Mailing Address - Phone:626-579-4274
Mailing Address - Fax:
Practice Address - Street 1:4161 TYLER AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1966
Practice Address - Country:US
Practice Address - Phone:626-579-4274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JORGE A VILLASENOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty