Icom Sunrise LLC

NPI #1093585853 in Sunrise, Florida

Provider Information

NPI Number: 1093585853
Entity Type: Organization
Organization Name: Icom Sunrise LLC
Primary Specialty: Dentist
Enumeration Date: Jan 3, 2024
Last Updated: Jan 3, 2024

Practice Location

Address: 12651 W SUNRISE BLVD
City: Sunrise
State: Florida
ZIP Code: 33323-0906
Phone: (954) 356-2721

Authorized Official

Name: TATIANA SANTIAGO HERZOG, DDS
Title: DENTIST
Phone: (954) 356-2721

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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