Provider Demographics
NPI:1851760599
Name:SUNRISE DENTAL
Entity Type:Organization
Organization Name:SUNRISE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-368-6261
Mailing Address - Street 1:428 HARBORVIEW DR SE
Mailing Address - Street 2:128
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2461
Mailing Address - Country:US
Mailing Address - Phone:360-697-2777
Mailing Address - Fax:
Practice Address - Street 1:428 HARBORVIEW DR SE
Practice Address - Street 2:128
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2461
Practice Address - Country:US
Practice Address - Phone:360-697-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60587957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty