Provider Demographics
NPI:1912463043
Name:SUNRISE DENTAL OF BELLINGHAM
Entity Type:Organization
Organization Name:SUNRISE DENTAL OF BELLINGHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YURIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGDASAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-840-4579
Mailing Address - Street 1:3800 BYRON AVE.
Mailing Address - Street 2:#100
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229
Mailing Address - Country:US
Mailing Address - Phone:360-840-4579
Mailing Address - Fax:
Practice Address - Street 1:3800 BYRON AVE.
Practice Address - Street 2:#100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229
Practice Address - Country:US
Practice Address - Phone:360-840-4579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty