Provider Demographics
NPI:1982973764
Name:SUNRISE DENTAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SUNRISE DENTAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORPHANOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-572-1500
Mailing Address - Street 1:6765 SUNSET STRIP
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2894
Mailing Address - Country:US
Mailing Address - Phone:954-572-1500
Mailing Address - Fax:954-572-8501
Practice Address - Street 1:6765 SUNSET STRIP
Practice Address - Street 2:SUITE 3
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2894
Practice Address - Country:US
Practice Address - Phone:954-572-1500
Practice Address - Fax:954-572-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075530300Medicaid