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General NPI Number Information
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NPI Number | 1770901001
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Entity Type | Organization
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Legal Business Name | SUN CITY DENTAL, PLLC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 11240 MONTWOOD DR SUITE J
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City | EL PASO
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State | TX
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Zip | 79936-4249
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Country | US
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Telephone | 915-201-2539
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Fax | 915-613-5082
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Provider Business Mailing Address
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Address Line | 11240 MONTWOOD DR SUITE J
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City | EL PASO
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State | TX
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Zip | 79936-4249
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Country | US
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Telephone | 915-201-2539
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Fax | 915-613-5082
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Authorized Official
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Title or Position | DIRECTOR/DENTIST
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Name | DR. IVEN GONZALEZ
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Credential | DDS
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Telephone | 915-201-2539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25489
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License Number State | TX
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