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General NPI Number Information
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NPI Number | 1255121018
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Entity Type | Organization
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Legal Business Name | SUN CITY ORAL SURGERY AND IMPLANT CENTER LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 8815 DYER ST # 215
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City | EL PASO
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State | TX
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Zip | 79904-2000
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Country | US
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Telephone | 915-200-2943
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Fax |
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Provider Business Mailing Address
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Address Line | 8815 DYER ST # 215
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City | EL PASO
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State | TX
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Zip | 79904-2000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JAKE WILLIAMS
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Credential | DDS
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Telephone | 385-335-0928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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