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General NPI Number Information
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NPI Number | 1790325884
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Entity Type | Organization
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Legal Business Name | BONITA SONRISA DENTAL MSO
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 1624 DR MARTIN L KING JR BLVD
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City | BRONX
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State | NY
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Zip | 10453-6948
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Country | US
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Telephone | 845-793-4469
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Fax | 718-450-8991
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Provider Business Mailing Address
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Address Line | 1624 UNIVERSITY AVE
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City | BRONX
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State | NY
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Zip | 10453-6948
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Country | US
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Telephone | 718-294-3725
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEJANDRO WILLIAMS
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Credential | DDS
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Telephone | 718-294-3725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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