Provider Demographics
NPI:1467865832
Name:SONRISAS DENTAL CENTER
Entity Type:Organization
Organization Name:SONRISAS DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:512-593-7970
Mailing Address - Street 1:1130 COTTONWOOD CREEK TRL
Mailing Address - Street 2:#A1
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7588
Mailing Address - Country:US
Mailing Address - Phone:512-593-7970
Mailing Address - Fax:
Practice Address - Street 1:1130 COTTONWOOD CREEK TRL
Practice Address - Street 2:#A1
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7588
Practice Address - Country:US
Practice Address - Phone:512-593-7970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297661223P0300X, 1223X0400X
TX278621223P0700X
TX278241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty