Provider Demographics
NPI:1245023399
Name:SUNSHINE SMILES PLLC
Entity type:Organization
Organization Name:SUNSHINE SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:TROCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DDS
Authorized Official - Phone:801-319-0603
Mailing Address - Street 1:6632 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2050
Mailing Address - Country:US
Mailing Address - Phone:918-364-2222
Mailing Address - Fax:
Practice Address - Street 1:427 STONE WOOD DR STE 427
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1026
Practice Address - Country:US
Practice Address - Phone:918-364-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200894410AMedicaid
OK200678140AMedicaid
OK200527720AMedicaid