Healthcare Provider Details

I. General information

NPI: 1093113318
Provider Name (Legal Business Name): SUNRISE OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 02/07/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 COURT STREET
MARSHFIELD ME
04654
US

IV. Provider business mailing address

26 HADLEY LAKE ROAD
MACHIAS ME
04654-0088
US

V. Phone/Fax

Practice location:
  • Phone: 207-255-8596
  • Fax: 207-255-6110
Mailing address:
  • Phone: 207-255-8596
  • Fax: 207-255-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2212
License Number StateME

VIII. Authorized Official

Name: CHRISTOPHER BRENT CASTON
Title or Position: BILLING MANAGER
Credential:
Phone: 207-255-0763