Provider Demographics
NPI:1689739690
Name:SUNRISE FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:SUNRISE FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-533-8150
Mailing Address - Street 1:25900 WEST SIX MILE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240
Mailing Address - Country:US
Mailing Address - Phone:313-533-8150
Mailing Address - Fax:
Practice Address - Street 1:25900 WEST SIX MILE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240
Practice Address - Country:US
Practice Address - Phone:313-533-8150
Practice Address - Fax:313-533-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty