MEDICARE: SUNSHINE DENTAL 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	122300000X	Dentist	TX 17538	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447312855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE DENTAL PA

Provider Business Mailing Address
First Line	:	3444 ELLA BLVD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77018-6100
Country	:	US
Telephone Number	:	713-681-0140
Fax Number	:	713-681-0127

Provider Business Practice Location Address
First Line	:	3444 ELLA BLVD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77018-6100
Country	:	US
Telephone Number	:	713-681-0140
Fax Number	:	713-681-0127

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. JAMES DAVID GINTER
Credential	:
Telephone Number	:	713-681-0140

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	09/06/2012

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Directions to “SUNSHINE DENTAL PA ” Practice Location

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