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General NPI Number Information
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NPI Number | 1386900991
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Entity Type | Organization
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Legal Business Name | SUN ORTHODONTIX OF LAS CRUCES, PLLC
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 920 N TELSHOR BLVD SUITE E
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City | LAS CRUCES
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State | NM
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Zip | 88011-8277
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Country | US
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Telephone | 575-521-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 S PADRE ISLAND DR SUITE 230B
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City | CORPUS CHRISTI
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State | TX
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Zip | 78416-1353
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Country | US
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Telephone | 361-654-5616
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CHRISTEL DINKLER
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Credential | CPA
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Telephone | 361-654-5616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | TX
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