| Organization Name: | SUNRISE SMILES LLC |
| NPI Number: | 1518372135 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LANA T INGALLS (INDEPENDENT DENTAL HYGIENIST) |
| Mailing Address: | 1166 Port Road Machiasport |
| State: | ME US |
| Postal Code: | 04655 |
| Phone Number: | 2072591129 |
| Fax Number: | |
| NPI Enumeration Date: | 06/23/2014 |
| NPI Last Update Date: | 06/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | IPH72 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |