MEDICARE: SUNRISE 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	1223G0001X	General Practice Dentistry	24028	TX

General Provider Information

NPI Number	:	1376977637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE DENTAL

Provider Business Mailing Address
First Line	:	4000 SUNRISE RD
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 SUNRISE RD
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1519
Country	:	US
Telephone Number	:	512-827-5413
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NATALIE SCOTT
Credential	:	DDS
Telephone Number	:	713-823-5413

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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