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General NPI Number Information
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NPI Number | 1205046810
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Entity Type | Organization
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Legal Business Name | SUNSHINE FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 408 W INTERLAKE BLVD
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City | LAKE PLACID
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State | FL
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Zip | 33852-0700
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Country | US
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Telephone | 863-465-2037
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Fax | 863-465-1155
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Provider Business Mailing Address
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Address Line | 408 W INTERLAKE BLVD
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City | LAKE PLACID
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State | FL
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Zip | 33852-0700
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Country | US
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Telephone | 863-465-2037
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Fax | 863-465-1155
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Authorized Official
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Title or Position | OFFICE MGR.
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Name | MONIQUE OXER
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Credential |
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Telephone | 863-465-2037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 15221
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License Number State | FL
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