Healthcare Provider Details

I. General information

NPI: 1689739690
Provider Name (Legal Business Name): SUNRISE FAMILY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25900 WEST SIX MILE
REDFORD MI
48240
US

IV. Provider business mailing address

25900 WEST SIX MILE
REDFORD MI
48240
US

V. Phone/Fax

Practice location:
  • Phone: 313-533-8150
  • Fax: 313-533-9777
Mailing address:
  • Phone: 313-533-8150
  • Fax:

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: DR. STEVEN ROBERT RODRIGUEZ
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 313-533-8150