Provider Demographics
NPI:1396167532
Name:SUNSHINE DENTAL PC
Entity type:Organization
Organization Name:SUNSHINE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AEKLAVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANJALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-779-8080
Mailing Address - Street 1:140 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3104
Mailing Address - Country:US
Mailing Address - Phone:315-779-8080
Mailing Address - Fax:855-217-1118
Practice Address - Street 1:140 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3104
Practice Address - Country:US
Practice Address - Phone:315-779-8080
Practice Address - Fax:855-217-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty