Provider Demographics
NPI:1619255791
Name:SUNRISE DENTAL SERVICE P.C.
Entity Type:Organization
Organization Name:SUNRISE DENTAL SERVICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOKKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKADIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-567-5566
Mailing Address - Street 1:1604 LAKELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1604 LAKELAND AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2146
Practice Address - Country:US
Practice Address - Phone:631-567-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-24
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDENTIST 0396911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty