Provider Demographics
NPI:1477702140
Name:SUN DENTAL INC
Entity Type:Organization
Organization Name:SUN DENTAL INC
Other - Org Name:PREMIER DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:JAYANT
Authorized Official - Last Name:PARIKSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-844-5520
Mailing Address - Street 1:1528 LAND O LAKES BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-2903
Mailing Address - Country:US
Mailing Address - Phone:813-948-0404
Mailing Address - Fax:813-948-4484
Practice Address - Street 1:1528 LAND O LAKES BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-2903
Practice Address - Country:US
Practice Address - Phone:813-948-0404
Practice Address - Fax:813-948-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13340122300000X
FLDN14074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty