Provider Demographics
NPI:1306898481
Name:NATIONAL ORTHODONTIX MANAGEMENT, LLC
Entity type:Organization
Organization Name:NATIONAL ORTHODONTIX MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:VONDRAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-853-1900
Mailing Address - Street 1:1620 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 230B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1353
Mailing Address - Country:US
Mailing Address - Phone:361-853-1900
Mailing Address - Fax:361-853-1904
Practice Address - Street 1:1620 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 230B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-1353
Practice Address - Country:US
Practice Address - Phone:361-853-1900
Practice Address - Fax:361-853-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX820296OtherUNITED CONCORDIA