Provider Demographics
NPI:1871323154
Name:SUNLIGHT DENTAL
Entity type:Organization
Organization Name:SUNLIGHT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-999-1200
Mailing Address - Street 1:13856 W WADDELL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-3801
Mailing Address - Country:US
Mailing Address - Phone:623-999-1200
Mailing Address - Fax:623-259-1258
Practice Address - Street 1:13856 W WADDELL RD STE 102
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-3801
Practice Address - Country:US
Practice Address - Phone:623-999-1200
Practice Address - Fax:623-259-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental