MEDICARE: SUNKIDZ PEDIATRIC DENTISTRY GROUP LLC

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	1223P0221X	Pediatric Dentistry	DN9103	FL

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	:	1801266762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNKIDZ PEDIATRIC DENTISTRY GROUP LLC

Provider Business Mailing Address
First Line	:	1045 NE 125TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5804
Country	:	US
Telephone Number	:	305-800-5439
Fax Number	:	305-372-4562

Provider Business Practice Location Address
First Line	:	1045 NE 125TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5804
Country	:	US
Telephone Number	:	305-800-5439
Fax Number	:	305-372-4562

Authorized Official
Title or Position	:	DMD
Name	:	DR. RITA PATEL
Credential	:
Telephone Number	:	305-800-5439

Provider Enumeration Date	:	10/04/2015
Last Update Date	:	10/13/2023

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