Healthcare Provider Details

I. General information

NPI: 1386900991
Provider Name (Legal Business Name): SUN ORTHODONTIX OF LAS CRUCES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N TELSHOR BLVD SUITE E
LAS CRUCES NM
88011-8277
US

IV. Provider business mailing address

1620 S PADRE ISLAND DR SUITE 230B
CORPUS CHRISTI TX
78416-1353
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-0900
  • Fax:
Mailing address:
  • Phone: 361-654-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateTX

VIII. Authorized Official

Name: CHRISTEL DINKLER
Title or Position: CFO
Credential: CPA
Phone: 361-654-5616