| Shiva Izaddoust D.d.s. P.a. | |
|
700 S Zarzamora St Ste 106 San Antonio TX 78207-5255 | |
| (210) 432-0298 | |
| (210) 432-6044 |
| Full Name | Shiva Izaddoust D.d.s. P.a. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 700 S Zarzamora St, San Antonio, Texas |
| Authorized Official Name and Position | Shiva Izaddoust (PRESIDENT) |
| Authorized Official Contact | 2104320298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shiva Izaddoust D.d.s. P.a. 700 S Zarzamora St Ste 106 San Antonio TX 78207-5255 Ph: (210) 432-0298 | Shiva Izaddoust D.d.s. P.a. 700 S Zarzamora St Ste 106 San Antonio TX 78207-5255 Ph: (210) 432-0298 |
| NPI Number | 1275667503 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275667503 | NPI | - | NPPES |
| 7028 | Other | TX | BLUE CROSS BLUE SHIELD |
| G60126-02 | Other | TX | TEXAS CHIP |
| 1300534 | Other | TX | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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