Provider Demographics
NPI:1316753833
Name:SUNSHINE STATE DENTAL GROUP , PA
Entity type:Organization
Organization Name:SUNSHINE STATE DENTAL GROUP , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:VANESA
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-683-4488
Mailing Address - Street 1:8136 OKEECHOBEE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2002
Mailing Address - Country:US
Mailing Address - Phone:561-683-4488
Mailing Address - Fax:561-683-4996
Practice Address - Street 1:8136 OKEECHOBEE BLVD STE B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2002
Practice Address - Country:US
Practice Address - Phone:561-683-4488
Practice Address - Fax:561-683-4996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE STATE DENTAL GROUP, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty