Provider Demographics
NPI:1710321682
Name:SUNRISEDENTALCENTERPLLC
Entity Type:Organization
Organization Name:SUNRISEDENTALCENTERPLLC
Other - Org Name:SUNRISE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SONG
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-869-9973
Mailing Address - Street 1:2707 N SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1931
Mailing Address - Country:US
Mailing Address - Phone:713-869-9973
Mailing Address - Fax:
Practice Address - Street 1:2707 N SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1931
Practice Address - Country:US
Practice Address - Phone:713-869-9973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty