| Implant & Periodontal Dentistry | |
|
6609 Blanco Rd Suite 125 San Antonio TX 78216-6152 | |
| (210) 341-1489 | |
| (210) 349-0618 |
| Full Name | Implant & Periodontal Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 6609 Blanco Rd, San Antonio, Texas |
| Authorized Official Name and Position | Tony Dacy (PRESIDENT) |
| Authorized Official Contact | 2103411489 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Implant & Periodontal Dentistry 6609 Blanco Rd Suite 125 San Antonio TX 78216-6152 Ph: (210) 341-1489 | Implant & Periodontal Dentistry 6609 Blanco Rd Suite 125 San Antonio TX 78216-6152 Ph: (210) 341-1489 |
| NPI Number | 1164623203 |
|---|---|
| Provider Enumeration Date | 05/29/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5799196648 |
|---|---|
| Medicare Enrollment ID | O20201124002707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164623203 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 21366 (Texas) | Primary |
| Provider Name | Justin A Dacy |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1740360338 PECOS PAC ID: 3274853585 Enrollment ID: I20201228000238 |
| Provider Name | Mitchell W Ponsford |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1073982252 PECOS PAC ID: 4183922321 Enrollment ID: I20201229002930 |
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