Provider Demographics
NPI:1720140098
Name:SUNRISE FAMILY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SUNRISE FAMILY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-424-9671
Mailing Address - Street 1:9477 NORTH TERRITORIAL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130
Mailing Address - Country:US
Mailing Address - Phone:734-424-9671
Mailing Address - Fax:734-424-9675
Practice Address - Street 1:9477 NORTH TERRITORIAL
Practice Address - Street 2:SUITE 130
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130
Practice Address - Country:US
Practice Address - Phone:734-424-9671
Practice Address - Fax:734-424-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty