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Organization
BERNARDINO OCTAVIO ELIZONDO D.D.S. P.C.
Active
Organization
BERNARDINO OCTAVIO ELIZONDO D.D.S. P.C.
Active
Other names
Sunshine Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNARDINO OCTAVIO ELIZONDO D.D.S. (OWNER/ PRESIDENT)
(956) 399-9929
Entity
Organization
Contact information
Practice address
1389 W US HIGHWAY 77, SUITE E, SAN BENITO, TX 78586-4161
(956) 399-9929
(956) 399-4855
Mailing address
1389 W US HIGHWAY 77, SUITE E, SAN BENITO, TX 78586-4161
(956) 399-9929
(956) 399-4855
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19338
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155609401
—
TX
01
—
G60092-01
TEXAS CHIP
TX
Enumeration date
08/16/2006
Last updated
04/23/2010
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