Provider Demographics
NPI:1750254355
Name:SONRISA DENTAL FLORIDA LLC LACH DENTAL SPECIALISTS
Entity type:Organization
Organization Name:SONRISA DENTAL FLORIDA LLC LACH DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KORKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-722-6460
Mailing Address - Street 1:3520 S MORGAN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1533
Mailing Address - Country:US
Mailing Address - Phone:773-823-7815
Mailing Address - Fax:312-893-2275
Practice Address - Street 1:4250 ALAFAYA TRL STE 180
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9419
Practice Address - Country:US
Practice Address - Phone:773-823-7815
Practice Address - Fax:312-722-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty