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7878 Gateway Blvd E Suite 201 El Paso TX 79915-1802 | |
| (915) 595-1200 | |
| (915) 590-9708 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 7878 Gateway Blvd E, El Paso, Texas |
| Authorized Official Name and Position | John G. Vondrak (OPERATING MANAGER) |
| Authorized Official Contact | 9155951200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7878 Gateway Blvd E Suite 201 El Paso TX 79915-1802 Ph: (915) 595-1200 | 7878 Gateway Blvd E Suite 201 El Paso TX 79915-1802 Ph: (915) 595-1200 |
| NPI Number | 1417123266 |
|---|---|
| Provider Enumeration Date | 05/01/2008 |
| Last Update Date | 05/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417123266 | NPI | - | NPPES |
| 009297504 | Medicaid | TX | |
| 1730151713 | Other | DR. VONDRAK'S INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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