| Sunkist Dental Office | |
|
2500 E Ball Rd Suite 150 Anaheim CA 92806-5054 | |
| (714) 533-9670 | |
| (714) 533-8509 |
| Full Name | Sunkist Dental Office |
|---|---|
| Speciality | Dentist |
| Location | 2500 E Ball Rd, Anaheim, California |
| Authorized Official Name and Position | Grishma Rajen Shah (PRESIDENT) |
| Authorized Official Contact | 7145339670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunkist Dental Office 2500 E Ball Rd Suite 150 Anaheim CA 92806-5054 Ph: (714) 533-9670 | Sunkist Dental Office 2500 E Ball Rd Suite 150 Anaheim CA 92806-5054 Ph: (714) 533-9670 |
| NPI Number | 1053431908 |
|---|---|
| Provider Enumeration Date | 04/01/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4587966122 |
|---|---|
| Medicare Enrollment ID | O20190328000451 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053431908 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 46958 (California) | Primary |
| Provider Name | Grishma R Shah |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1245383280 PECOS PAC ID: 1557663101 Enrollment ID: I20190513000944 |
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