Provider Demographics
NPI:1457961492
Name:SONRISAS DENTAL CENTER SOUTH, LLC
Entity Type:Organization
Organization Name:SONRISAS DENTAL CENTER SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:737-781-9438
Mailing Address - Street 1:505 W LOUIS HENNA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-1702
Mailing Address - Country:US
Mailing Address - Phone:512-593-7970
Mailing Address - Fax:
Practice Address - Street 1:1217 W SLAUGHTER LN STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6912
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:2020-08-05
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty