Provider Demographics
NPI:1487667804
Name:SUN EAST DENTAL P.A.
Entity Type:Organization
Organization Name:SUN EAST DENTAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:VERNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-885-5351
Mailing Address - Street 1:19620 PINES BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1301
Mailing Address - Country:US
Mailing Address - Phone:954-885-5351
Mailing Address - Fax:954-885-5352
Practice Address - Street 1:19620 PINES BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1301
Practice Address - Country:US
Practice Address - Phone:954-885-5351
Practice Address - Fax:954-885-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty