| Sunset Dental Group Inc. | |
|
1906 N Broadway Santa Ana CA 92706-2610 | |
| (714) 547-6671 | |
| (714) 547-4385 |
| Full Name | Sunset Dental Group Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1906 N Broadway, Santa Ana, California |
| Authorized Official Name and Position | Jerry Lee Kronquist (OFFICE MANAGER) |
| Authorized Official Contact | 1714547667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunset Dental Group Inc. 1906 N Broadway Santa Ana CA 92706-2610 Ph: (714) 547-6671 | Sunset Dental Group Inc. 1906 N Broadway Santa Ana CA 92706-2610 Ph: (714) 547-6671 |
| NPI Number | 1548445463 |
|---|---|
| Provider Enumeration Date | 01/09/2008 |
| Last Update Date | 08/11/2022 |
| Medicare PECOS PAC ID | 7214237791 |
|---|---|
| Medicare Enrollment ID | O20220512002394 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548445463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30388 (California) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Jerry Lee Kronquist |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1114132636 PECOS PAC ID: 2860707247 Enrollment ID: I20220512002435 |
| Provider Name | Zakary Adam Kronquist |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1295221307 PECOS PAC ID: 0446631782 Enrollment ID: I20220719001000 |
| Provider Name | Amanda Rae Kronquist |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1245609734 PECOS PAC ID: 8729462627 Enrollment ID: I20220825003939 |
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