| Sun Orthodontix Of Las Cruces Pllc | |
|
920 N Telshor Blvd Suite E Las Cruces NM 88011-8244 | |
| (575) 521-0900 | |
| (575) 521-0128 |
| Full Name | Sun Orthodontix Of Las Cruces Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 920 N Telshor Blvd, Las Cruces, New Mexico |
| Authorized Official Name and Position | John G. Vondrak (OPERATING MANAGER) |
| Authorized Official Contact | 5055210900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sun Orthodontix Of Las Cruces Pllc 920 N Telshor Blvd Suite E Las Cruces NM 88011-8244 Ph: (575) 521-0900 | Sun Orthodontix Of Las Cruces Pllc 920 N Telshor Blvd Suite E Las Cruces NM 88011-8244 Ph: (575) 521-0900 |
| NPI Number | 1093767212 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 12/19/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093767212 | NPI | - | NPPES |
| 105971 | Medicaid | NM | |
| 00785351 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | DD2276 (New Mexico) | Primary |
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