Provider Demographics
NPI:1588815799
Name:SUNRISE DENTAL DR. DINAH B. VICE AND ASSOCIATES
Entity Type:Organization
Organization Name:SUNRISE DENTAL DR. DINAH B. VICE AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:VICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-493-3355
Mailing Address - Street 1:8128 RENAISSANCE PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6695
Mailing Address - Country:US
Mailing Address - Phone:919-493-3355
Mailing Address - Fax:919-361-3317
Practice Address - Street 1:8128 RENAISSANCE PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6695
Practice Address - Country:US
Practice Address - Phone:919-493-3355
Practice Address - Fax:919-361-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty