Provider Demographics
NPI:1508536129
Name:SONRISA FAMILY DENTAL GEORGIA II LLC
Entity Type:Organization
Organization Name:SONRISA FAMILY DENTAL GEORGIA II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KORKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-925-0042
Mailing Address - Street 1:3520 S MORGAN ST STE 207-208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1533
Mailing Address - Country:US
Mailing Address - Phone:312-722-6460
Mailing Address - Fax:312-893-2275
Practice Address - Street 1:1200 SHERWOOD PARK DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3445
Practice Address - Country:US
Practice Address - Phone:678-383-4180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty