| The Light Family Dental And Implant Dentistry Pllc | |
|
8214 Fm-78 Suite 105 Converse TX 78109 | |
| (210) 920-4963 | |
| (210) 783-8656 |
| Full Name | The Light Family Dental And Implant Dentistry Pllc |
|---|---|
| Speciality | Dentist |
| Location | 8214 Fm-78, Converse, Texas |
| Authorized Official Name and Position | Andrew Akindutire (DMD) |
| Authorized Official Contact | 3017955013 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Light Family Dental And Implant Dentistry Pllc 8214 Fm-78 Suite 105 Converse TX 78109 Ph: (210) 920-4963 | The Light Family Dental And Implant Dentistry Pllc 8214 Fm-78 Suite 105 Converse TX 78109 Ph: (210) 920-4963 |
| NPI Number | 1912617929 |
|---|---|
| Provider Enumeration Date | 11/30/2022 |
| Last Update Date | 12/19/2022 |
| Medicare PECOS PAC ID | 6800268517 |
|---|---|
| Medicare Enrollment ID | O20230206003043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912617929 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| Provider Name | Andrew Akindutire |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1104470368 PECOS PAC ID: 7618349325 Enrollment ID: I20230206003089 |
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