MEDICARE: SUNSHINE STATE DENTAL GROUP , PA

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1316753833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE STATE DENTAL GROUP , PA

Provider Business Mailing Address
First Line	:	8136 OKEECHOBEE BLVD STE B
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2002
Country	:	US
Telephone Number	:	561-683-4488
Fax Number	:	561-683-4996

Provider Business Practice Location Address
First Line	:	8136 OKEECHOBEE BLVD STE B
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2002
Country	:	US
Telephone Number	:	561-683-4488
Fax Number	:	561-683-4996

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. VERONICA VANESA SILVA
Credential	:
Telephone Number	:	561-683-4488

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/09/2024

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Directions to “SUNSHINE STATE DENTAL GROUP , PA ” Practice Location

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