| Bigway Family Dental Pllc | |
|
11930 U.s . Hwy. 90, West Suite 106 San Antonio TX 78252 | |
| (240) 528-1096 | |
| Not Available |
| Full Name | Bigway Family Dental Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11930 U.s . Hwy. 90, West, San Antonio, Texas |
| Authorized Official Name and Position | Ayodele Oluropo Ifarajimi (OWNER) |
| Authorized Official Contact | 2405281096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bigway Family Dental Pllc 11930 W Us Highway 90 Ste 106 San Antonio TX 78245-9613 Ph: (210) 858-5570 | Bigway Family Dental Pllc 11930 U.s . Hwy. 90, West Suite 106 San Antonio TX 78252 Ph: (240) 528-1096 |
| NPI Number | 1902410699 |
|---|---|
| Provider Enumeration Date | 09/01/2020 |
| Last Update Date | 03/09/2021 |
| Medicare PECOS PAC ID | 7719394592 |
|---|---|
| Medicare Enrollment ID | O20210323000265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902410699 | NPI | - | NPPES |
| 384599215 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Ayodele Oluropo Ifarajimi |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1982197497 PECOS PAC ID: 8628485406 Enrollment ID: I20210323000297 |
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