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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