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General NPI Number Information
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NPI Number | 1710321682
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Entity Type | Organization
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Legal Business Name | SUNRISEDENTALCENTERPLLC
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 2707 N SHEPHERD DR
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City | HOUSTON
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State | TX
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Zip | 77008-1931
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Country | US
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Telephone | 713-869-9973
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Fax |
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Provider Business Mailing Address
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Address Line | 2707 N SHEPHERD DR
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City | HOUSTON
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State | TX
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Zip | 77008-1931
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Country | US
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Telephone | 713-869-9973
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SONG AHN
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Credential |
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Telephone | 713-869-9973
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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 |
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License Number State |
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