| Seville Park Endodontics Pllc | |
|
8211 Fredericksburg Rd San Antonio TX 78229 | |
| (210) 617-5536 | |
| (210) 614-4266 |
| Full Name | Seville Park Endodontics Pllc |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 8211 Fredericksburg Rd, San Antonio, Texas |
| Authorized Official Name and Position | Timothy A Ingram (ENDODONTIST) |
| Authorized Official Contact | 2106178536 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Seville Park Endodontics Pllc 8211 Fredericksburg Rd San Antonio TX 78229 Ph: (210) 617-5536 | Seville Park Endodontics Pllc 8211 Fredericksburg Rd San Antonio TX 78229 Ph: (210) 617-5536 |
| NPI Number | 1740376540 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740376540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 17400 (Texas) | Primary |
| 1223E0200X | Dentist - Endodontics | 18608 (Texas) | Secondary |
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