Provider Demographics
NPI:1225369978
Name:SUN ORTHODONTIX OF VICTORIA, PLLC
Entity Type:Organization
Organization Name:SUN ORTHODONTIX OF VICTORIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-654-5616
Mailing Address - Street 1:1620 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1353
Mailing Address - Country:US
Mailing Address - Phone:361-853-1900
Mailing Address - Fax:
Practice Address - Street 1:7002 NE ZAC LENTZ PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3450
Practice Address - Country:US
Practice Address - Phone:361-573-7464
Practice Address - Fax:361-573-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009297503Medicaid
TX1609089978Medicaid
TX168370801Medicaid
TX1609883404Medicaid
TX1295991271Medicaid
TX1801975636OtherNPI