Provider Demographics
NPI:1760159305
Name:SONRISA BRIGHT DENTAL GROUP #2
Entity Type:Organization
Organization Name:SONRISA BRIGHT DENTAL GROUP #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICCHON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-713-8986
Mailing Address - Street 1:1041 MCKEEVER AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4022
Mailing Address - Country:US
Mailing Address - Phone:510-460-9366
Mailing Address - Fax:510-460-9436
Practice Address - Street 1:1041 MCKEEVER AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4022
Practice Address - Country:US
Practice Address - Phone:510-460-9366
Practice Address - Fax:510-460-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609060649OtherNEA