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General NPI Number Information
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NPI Number | 1982571436
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Entity Type | Organization
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Legal Business Name | SONRISA PANAMA CITY LLC
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 1560 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4621
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Country | US
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Telephone | 773-823-7815
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Fax | 312-893-2275
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Provider Business Mailing Address
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Address Line | 3520 S MORGAN ST STE 207
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City | CHICAGO
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State | IL
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Zip | 60609-1533
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Country | US
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Telephone | 773-823-7815
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Fax | 312-893-2275
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON KORKUS
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Credential | DDS
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Telephone | 312-722-6460
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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 |
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License Number State |
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