| Icom Sunrise Llc | |
|
12651 W Sunrise Blvd Sunrise FL 33323-0906 | |
| (954) 356-2721 | |
| (786) 221-4442 |
| Full Name | Icom Sunrise Llc |
|---|---|
| Speciality | Dentist |
| Location | 12651 W Sunrise Blvd, Sunrise, Florida |
| Authorized Official Name and Position | Tatiana Santiago Herzog (DENTIST) |
| Authorized Official Contact | 9543562721 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icom Sunrise Llc 611 Ne 13th St Ft Lauderdale FL 33304-1109 Ph: (305) 409-5392 | Icom Sunrise Llc 12651 W Sunrise Blvd Sunrise FL 33323-0906 Ph: (954) 356-2721 |
| NPI Number | 1093585853 |
|---|---|
| Provider Enumeration Date | 01/03/2024 |
| Last Update Date | 01/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093585853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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