Healthcare Provider Details

I. General information

NPI: 1679032619
Provider Name (Legal Business Name): SUNSHINE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 CONNECTICUT AVE NW STE 146
WASHINGTON DC
20008-2386
US

IV. Provider business mailing address

4301 CONNECTICUT AVE NW STE 146
WASHINGTON DC
20008-2386
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-4010
  • Fax: 202-244-8847
Mailing address:
  • Phone: 202-244-4010
  • Fax: 202-244-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SAREETA R GUPTA
Title or Position: OWNER
Credential: DDS
Phone: 202-244-4010