Provider Demographics
NPI:1265722490
Name:SUNSHINE DENTAL, INC.
Entity type:Organization
Organization Name:SUNSHINE DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERCURIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-842-5005
Mailing Address - Street 1:9 MIDDLETOWN LINCROFT RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1511
Mailing Address - Country:US
Mailing Address - Phone:732-842-5005
Mailing Address - Fax:732-842-8608
Practice Address - Street 1:9 MIDDLETOWN LINCROFT RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1511
Practice Address - Country:US
Practice Address - Phone:732-842-5005
Practice Address - Fax:732-842-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01142300261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental