Provider Demographics
NPI:1447312855
Name:SUNSHINE DENTAL PA
Entity type:Organization
Organization Name:SUNSHINE DENTAL PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-681-0140
Mailing Address - Street 1:3444 ELLA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6100
Mailing Address - Country:US
Mailing Address - Phone:713-681-0140
Mailing Address - Fax:713-681-0127
Practice Address - Street 1:3444 ELLA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6100
Practice Address - Country:US
Practice Address - Phone:713-681-0140
Practice Address - Fax:713-681-0127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE DENTAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 17538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174560601Medicaid