Provider Demographics
NPI:1023124997
Name:SUNRISE DENTAL
Entity type:Organization
Organization Name:SUNRISE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:BLACK
Authorized Official - Last Name:VICE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-878-0055
Mailing Address - Street 1:1009 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5833
Mailing Address - Country:US
Mailing Address - Phone:919-878-0055
Mailing Address - Fax:919-878-0096
Practice Address - Street 1:1009 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5833
Practice Address - Country:US
Practice Address - Phone:919-878-0055
Practice Address - Fax:919-878-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty