| Centromed South Park Dental | |
|
910 Wagner Ave San Antonio TX 78211-3213 | |
| (210) 924-7344 | |
| (210) 923-7929 |
| Full Name | Centromed South Park Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 910 Wagner Ave, San Antonio, Texas |
| Authorized Official Name and Position | Chuck Walzel (CFO) |
| Authorized Official Contact | 2103343724 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centromed South Park Dental 3750 Commercial Ave San Antonio TX 78221-3117 Ph: (210) 334-3700 | Centromed South Park Dental 910 Wagner Ave San Antonio TX 78211-3213 Ph: (210) 924-7344 |
| NPI Number | 1497935233 |
|---|---|
| Provider Enumeration Date | 11/09/2007 |
| Last Update Date | 06/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497935233 | NPI | - | NPPES |
| 120980103 | Medicaid | TX | |
| 00MT08 | Other | TX | GROUP MEDICARE |
| 120980102 | Medicaid | TX | |
| 102980101 | Medicaid | TX | |
| G60232-02 | Other | TX | DELTA DENTAL |
| 120980105 | Medicaid | TX |
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