Healthcare Provider Details

I. General information

NPI: 1750254355
Provider Name (Legal Business Name): SONRISA DENTAL FLORIDA LLC LACH DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 ALAFAYA TRL STE 180
OVIEDO FL
32765-9419
US

IV. Provider business mailing address

3520 S MORGAN ST STE 207
CHICAGO IL
60609-1533
US

V. Phone/Fax

Practice location:
  • Phone: 773-823-7815
  • Fax: 312-722-6460
Mailing address:
  • Phone: 773-823-7815
  • Fax: 312-893-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JASON KORKUS
Title or Position: PRESIDENT
Credential: DDS
Phone: 312-722-6460