| Dental Office | |
|
600 Division Ave Suite A San Antonio TX 78214-1350 | |
| (210) 342-2000 | |
| (210) 342-2517 |
| Full Name | Dental Office |
|---|---|
| Speciality | Clinic/center |
| Location | 600 Division Ave, San Antonio, Texas |
| Authorized Official Name and Position | Barbara Mata (OFFICE MANAGER) |
| Authorized Official Contact | 2103422000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Office 8261 Fredericksburg Rd San Antonio TX 78229-3357 Ph: (210) 924-7277 | Dental Office 600 Division Ave Suite A San Antonio TX 78214-1350 Ph: (210) 342-2000 |
| NPI Number | 1750409686 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 04/25/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750409686 | NPI | - | NPPES |
| 155832201 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 20176 (Texas) | Secondary |
| 261Q00000X | Clinic/center | 20173 (Texas) | Primary |
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