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General NPI Number Information
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NPI Number | 1003299173
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Entity Type | Organization
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Legal Business Name | SUNSHINE DENTAL, PC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 10411 LAGRIMA DE ORO RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3727
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Country | US
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Telephone | 505-298-0456
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Fax | 505-298-4467
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Provider Business Mailing Address
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Address Line | 10411 LAGRIMA DE ORO RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3727
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Country | US
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Telephone | 505-298-0456
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Fax | 505-298-4467
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LILIAN HAYDEE JAIME
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Credential | DMD
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Telephone | 505-298-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1865
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License Number State | NM
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