MEDICARE: SUNHEART DENTAL

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	261QD0000X	Dental Clinic/Center	DN17610	FL

General Provider Information

NPI Number	:	1174916050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNHEART DENTAL

Provider Business Mailing Address
First Line	:	628 SW 5TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1024
Country	:	US
Telephone Number	:	954-294-2363
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S FEDERAL HWY
Second Line	:	SUITE #829
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-4374
Country	:	US
Telephone Number	:	954-925-2977
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALYSSA HILLMAN PINNOCK
Credential	:	D.M.D.
Telephone Number	:	954-294-2363

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	03/16/2015

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Directions to “SUNHEART DENTAL ” Practice Location

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