Healthcare Provider Details

I. General information

NPI: 1588935365
Provider Name (Legal Business Name): SUNSHINE PEDIATRIC DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6530
US

IV. Provider business mailing address

5000 HOLLYWOOD BLVD SUITE 1
HOLLYWOOD FL
33021
US

V. Phone/Fax

Practice location:
  • Phone: 954-989-4400
  • Fax:
Mailing address:
  • Phone: 954-989-4400
  • Fax: 954-989-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL BRODY
Title or Position: OWNER
Credential: D.D.S
Phone: 305-535-8001