Provider Demographics
NPI:1558627166
Name:SUN ORTHODONTIX OF VICTORIA, PLLC
Entity Type:Organization
Organization Name:SUN ORTHODONTIX OF VICTORIA, PLLC
Other - Org Name:SUN ORTHODONTIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:361-654-5616
Mailing Address - Street 1:1620 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 230B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1353
Mailing Address - Country:US
Mailing Address - Phone:361-654-5616
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty