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930 S Alamo San Antonio TX 78205-3419 | |
| (210) 227-0101 | |
| (210) 212-6125 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 930 S Alamo, San Antonio, Texas |
| Authorized Official Name and Position | Gary Peter Guillory (PRESIDENT/MANAGER) |
| Authorized Official Contact | 2102270101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
930 S Alamo San Antonio TX 78205-3419 Ph: (210) 227-0101 | 930 S Alamo San Antonio TX 78205-3419 Ph: (210) 227-0101 |
| NPI Number | 1366533747 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 03/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366533747 | NPI | - | NPPES |
| 695689 | Other | TX | UNITED CONCORDIA INS. |
| 0905986-02 | Medicaid | TX | |
| B16271 | Other | TX | DELTA DENTAL TEXAS CHIP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 16271 TX (Texas) | Primary |
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