NPIMap

Organization Active NPI

Bernardino Octavio Elizondo D.D.S. P.C.

Doing business as Sunshine Family Dentistry

  • Dentist
  • San Benito, TX
National Provider Identifier
1851404420
Registry record updated Apr 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19338 Issued in TX
Legal business name
BERNARDINO OCTAVIO ELIZONDO D.D.S. P.C.
Doing business as
Sunshine Family Dentistry
Practice address
1389 W US Highway 77
Suite E
San Benito, TX 78586-4161
Phone
(956) 399-9929
Fax
(956) 399-4855
NPI assigned
Aug 16, 2006
Last updated
Apr 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bernardino Octavio Elizondo, D.D.S.NPI 1265418487
Title
Owner/ President
Phone
(956) 399-9929

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 19338 TX Primary

Addresses

Primary practice location

1389 W US Highway 77
Suite E
San Benito, TX 78586-4161

Mailing address

1389 W US Highway 77
Suite E
San Benito, TX 78586-4161
Phone (956) 399-9929

Other identifiers 2

IdentifierTypeStateIssuer
155609401MedicaidTX
G60092-01OtherTXTEXAS CHIP

Other names 1

  • Sunshine Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bernardino Octavio Elizondo DDS PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1389 W US Highway 77
Ste E
San Benito, TX 78586
Phone (956) 399-9929

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271980800000",
    "number": "1851404420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1389 W US HIGHWAY 77",
            "address_2": "SUITE E",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785864161",
            "telephone_number": "956-399-9929",
            "fax_number": "956-399-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 W US HIGHWAY 77",
            "address_2": "SUITE E",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785864161",
            "telephone_number": "956-399-9929",
            "fax_number": "956-399-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERNARDINO OCTAVIO ELIZONDO D.D.S. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2010-04-23",
        "status": "A",
        "authorized_official_last_name": "ELIZONDO",
        "authorized_official_first_name": "BERNARDINO",
        "authorized_official_middle_name": "OCTAVIO",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "956-399-9929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "19338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155609401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS CHIP",
            "identifier": "G60092-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunshine Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Benito, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.