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NPI Code Detail

MEDICARE: CELEBRACES MARBACH

MEDICARE: CELEBRACES MARBACH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry24904TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043642994
Entity Type Code : Organization
Provider Name (Legal Business Name) : CELEBRACES MARBACH
Provider Business Mailing Address
First Line : 8700 MARBACH RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78227-2345
Country : US
Telephone Number : 210-675-7000
Fax Number : 210-675-7005
Provider Business Practice Location Address
First Line : 8700 MARBACH RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78227-2345
Country : US
Telephone Number : 210-675-7000
Fax Number : 210-675-7005
Authorized Official
Title or Position : MANAGER
Name : DR. DAVID B FERGUSON
Credential : DDS, CAGS
Telephone Number : 210-675-7000
Provider Enumeration Date : 08/02/2013
Last Update Date : 08/02/2013

Similar Medicare Providers

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Practice Location Address:
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1316386006 — DR. SETH W HUISH DMD
Practice Location Address:
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Practice Phone: 503-964-1765
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1033547765 — CELEBRATE DENTAL MARBACH PLLC
Practice Location Address:
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Practice Fax:
1487058442 — CFSA PLLC
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Directions to “CELEBRACES MARBACH ” Practice Location

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