MEDICARE: SUNSET ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	046790	NY

General Provider Information

NPI Number	:	1063886570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET ORTHODONTICS

Provider Business Mailing Address
First Line	:	476 48TH ST
Second Line	:	SUITE 3
City	:	BROOKLYN
State	:	NY
Zip	:	11220-6844
Country	:	US
Telephone Number	:	718-439-2822
Fax Number	:	718-439-2821

Provider Business Practice Location Address
First Line	:	476 48TH ST
Second Line	:	SUITE 3
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1954
Country	:	US
Telephone Number	:	718-439-2822
Fax Number	:	718-439-2821

Authorized Official
Title or Position	:	PRESIDENT / ORTHODONTIST
Name	:	DR. INGRID BARILLAS- ARIAS
Credential	:	DDS
Telephone Number	:	718-439-2822

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/20/2015

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Directions to “SUNSET ORTHODONTICS ” Practice Location

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