Healthcare Provider Details

I. General information

NPI: 1154151678
Provider Name (Legal Business Name): SUNRAY FAMILY DENTISTRY CENTRAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4329 MONTANA AVE
EL PASO TX
79903-4610
US

IV. Provider business mailing address

4329 MONTANA AVE
EL PASO TX
79903-4610
US

V. Phone/Fax

Practice location:
  • Phone: 915-320-1800
  • Fax: 915-320-1801
Mailing address:
  • Phone: 915-320-1800
  • Fax: 915-320-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEJANDRO ALONSO
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 347-520-0318