Healthcare Provider Details

I. General information

NPI: 1962299180
Provider Name (Legal Business Name): SUNRISE ENDODONTICS AND MICROSURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 LYNN DR
SANTA ROSA BEACH FL
32459-4200
US

IV. Provider business mailing address

231 WHITE OAKS BLVD
PANAMA CITY FL
32409-2370
US

V. Phone/Fax

Practice location:
  • Phone: 941-525-6931
  • Fax:
Mailing address:
  • Phone: 941-525-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA D ALLORE
Title or Position: OWNER
Credential: DMD
Phone: 941-525-6931