Provider Demographics
NPI:1568807113
Name:SUNSHINE MOBILE DENTISTRY
Entity Type:Organization
Organization Name:SUNSHINE MOBILE DENTISTRY
Other - Org Name:SUNSHINE MOBILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-554-7290
Mailing Address - Street 1:PO BOX 802833
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-2833
Mailing Address - Country:US
Mailing Address - Phone:214-554-7290
Mailing Address - Fax:972-692-5913
Practice Address - Street 1:15110 DALLAS PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4635
Practice Address - Country:US
Practice Address - Phone:972-554-7290
Practice Address - Fax:972-692-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty