Provider Demographics
NPI:1417123266
Name:NATIONAL ORTHODONTIX MANAGEMENT, LLC
Entity Type:Organization
Organization Name:NATIONAL ORTHODONTIX MANAGEMENT, LLC
Other - Org Name:SUN ORTHODONTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING MANAGER
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:915-595-1200
Mailing Address - Street 1:7878 GATEWAY BLVD E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1802
Mailing Address - Country:US
Mailing Address - Phone:915-595-1200
Mailing Address - Fax:915-590-9708
Practice Address - Street 1:7878 GATEWAY BLVD E
Practice Address - Street 2:SUITE 201
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1802
Practice Address - Country:US
Practice Address - Phone:915-595-1200
Practice Address - Fax:915-590-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009297504Medicaid
1730151713OtherDR. VONDRAK'S INDIVIDUAL NPI