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General NPI Number Information
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NPI Number | 1003028572
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Entity Type | Organization
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Legal Business Name | SUNRISE SMILE CENTER LLC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 3029 N ALMA SCHOOL RD SUITE 110
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City | CHANDLER
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State | AZ
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Zip | 85224-1464
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Country | US
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Telephone | 480-993-3870
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Fax | 480-777-5958
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Provider Business Mailing Address
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Address Line | 3029 N ALMA SCHOOL RD SUITE 110
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City | CHANDLER
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State | AZ
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Zip | 85224-1464
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Country | US
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Telephone | 480-993-3870
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Fax | 480-777-5958
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Authorized Official
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Title or Position | DENTIST
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Name | DR. OLGA REVILLA NOURI
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Credential | DMD
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Telephone | 480-993-3870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5737
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License Number State | AZ
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