Provider Demographics
NPI:1447841416
Name:SUNSHINE DENTISTRY LLC
Entity type:Organization
Organization Name:SUNSHINE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:PADMALATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-521-0999
Mailing Address - Street 1:87 CROSS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8440
Mailing Address - Country:US
Mailing Address - Phone:904-521-0999
Mailing Address - Fax:
Practice Address - Street 1:2921 S ORLANDO DR STE 146
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4105
Practice Address - Country:US
Practice Address - Phone:407-322-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental