# SUNRISE ORAL SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013773001
- **Authorized official:** MAX MCCUSKER (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (949) 521-2757

## Contact information

- **Practice address:** 16069 COMPRINT CIR, GAITHERSBURG, MD 20877-1321
- **Practice address phone:** (301) 762-0062
- **Practice address fax:** (301) 762-9110
- **Mailing address:** 285 W 530 N, VINEYARD, UT 84059-4817
- **Mailing address phone:** (949) 521-2757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 02/27/2024
- **Last updated:** 02/29/2024