Provider Demographics
NPI:1639571607
Name:SUNSET CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:SUNSET CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-807-2787
Mailing Address - Street 1:5080 SUNSET BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7051
Mailing Address - Country:US
Mailing Address - Phone:803-807-2787
Mailing Address - Fax:
Practice Address - Street 1:5080 SUNSET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7051
Practice Address - Country:US
Practice Address - Phone:803-807-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty