Provider Demographics
NPI:1467100412
Name:LITTLE SONRISAS PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:LITTLE SONRISAS PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SIEDOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-933-2372
Mailing Address - Street 1:504 E YUCCA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2365
Mailing Address - Country:US
Mailing Address - Phone:720-933-2372
Mailing Address - Fax:
Practice Address - Street 1:5300 N G ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4893
Practice Address - Country:US
Practice Address - Phone:956-414-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty