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General NPI Number Information
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NPI Number | 1518372135
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Entity Type | Organization
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Legal Business Name | SUNRISE SMILES LLC
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 1166 PORT ROAD
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City | MACHIASPORT
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State | ME
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Zip | 04655
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Country | US
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Telephone | 207-259-1129
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | MACHIASPORT
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State | ME
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Zip | 04655-0034
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Country | US
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Telephone | 207-259-1129
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Fax |
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Authorized Official
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Title or Position | INDEPENDENT DENTAL HYGIENIST
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Name | LANA T INGALLS
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Credential | IPDH
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Telephone | 207-259-1129
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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 | IPH72
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License Number State | ME
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