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General NPI Number Information
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NPI Number | 1568807113
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Entity Type | Organization
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Legal Business Name | SUNSHINE MOBILE DENTISTRY
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 15110 DALLAS PKWY SUITE 400
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City | DALLAS
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State | TX
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Zip | 75248-4635
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Country | US
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Telephone | 972-554-7290
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Fax | 972-692-5913
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Provider Business Mailing Address
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Address Line | PO BOX 802833
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City | DALLAS
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State | TX
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Zip | 75380-2833
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Country | US
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Telephone | 214-554-7290
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Fax | 972-692-5913
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. STEPHEN O'BRIEN
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Credential | DDS
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Telephone | 214-554-7290
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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 | 14346
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License Number State | TX
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