Provider Demographics
NPI:1770901001
Name:SUN CITY DENTAL, PLLC
Entity type:Organization
Organization Name:SUN CITY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-201-2539
Mailing Address - Street 1:11240 MONTWOOD DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4249
Mailing Address - Country:US
Mailing Address - Phone:915-201-2539
Mailing Address - Fax:915-613-5082
Practice Address - Street 1:11240 MONTWOOD DR
Practice Address - Street 2:SUITE J
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4249
Practice Address - Country:US
Practice Address - Phone:915-201-2539
Practice Address - Fax:915-613-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX254891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32048136579OtherTEXAS TAX PAYER NUMBER