| Kusom Dental Broadway Pllc | |
|
8852 Broadway # 201 San Antonio TX 78217-6318 | |
| (210) 888-0700 | |
| Not Available |
| Full Name | Kusom Dental Broadway Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8852 Broadway # 201, San Antonio, Texas |
| Authorized Official Name and Position | Selinda Gonzalez (OFFICE MANAGER) |
| Authorized Official Contact | 2108880700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kusom Dental Broadway Pllc 18707 Hardy Oak Blvd Ste 305 San Antonio TX 78258-4895 Ph: (210) 888-0700 | Kusom Dental Broadway Pllc 8852 Broadway # 201 San Antonio TX 78217-6318 Ph: (210) 888-0700 |
| NPI Number | 1265204622 |
|---|---|
| Provider Enumeration Date | 10/27/2023 |
| Last Update Date | 05/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265204622 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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