Provider Demographics
NPI:1285419564
Name:SUNBURST DENTAL LLC
Entity type:Organization
Organization Name:SUNBURST DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:575-526-4334
Mailing Address - Street 1:2010 E LOHMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3109
Mailing Address - Country:US
Mailing Address - Phone:575-526-4334
Mailing Address - Fax:
Practice Address - Street 1:2010 E LOHMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3109
Practice Address - Country:US
Practice Address - Phone:575-526-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty