Provider Demographics
NPI:1497536221
Name:SUNKIDZ PEDIATRIC DENTISTRY GROUP PLANTATION LLC
Entity Type:Organization
Organization Name:SUNKIDZ PEDIATRIC DENTISTRY GROUP PLANTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-800-5439
Mailing Address - Street 1:691 CARROTWOOD TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-8223
Mailing Address - Country:US
Mailing Address - Phone:305-310-6858
Mailing Address - Fax:
Practice Address - Street 1:9675 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2321
Practice Address - Country:US
Practice Address - Phone:305-310-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015581100Medicaid