Healthcare Provider Details

I. General information

NPI: 1700343233
Provider Name (Legal Business Name): BONITA SONRISA DENTAL IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 DR MARTIN L KING JR BLVD
BRONX NY
10453-6948
US

IV. Provider business mailing address

1624 UNIVERSITY AVE BSMT
BRONX NY
10453-6948
US

V. Phone/Fax

Practice location:
  • Phone: 845-793-4469
  • Fax: 718-450-8991
Mailing address:
  • Phone: 718-294-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEJANDRO WILLIAMS
Title or Position: PRESIDENT/OWNER
Credential: D.D.S
Phone: 917-335-3722