Provider Demographics
NPI:1164736500
Name:SUN ORTHODONTIX OF FAR EAST EL PASO PLLC
Entity Type:Organization
Organization Name:SUN ORTHODONTIX OF FAR EAST EL PASO PLLC
Other - Org Name:SUN ORTHODONTIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:VONDRAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-231-9983
Mailing Address - Street 1:7500 N MESA ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3501
Mailing Address - Country:US
Mailing Address - Phone:915-231-9983
Mailing Address - Fax:915-231-9966
Practice Address - Street 1:1971 ZARAGOZA RD
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-7983
Practice Address - Country:US
Practice Address - Phone:915-849-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty