MEDICARE: BULVERDE 7TO7 PLLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1043985070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BULVERDE 7TO7 PLLC

Provider Business Mailing Address
First Line	:	PO BOX 461649
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78246-1649
Country	:	US
Telephone Number	:	210-495-2000
Fax Number	:	210-495-2001

Provider Business Practice Location Address
First Line	:	17122 BULVERDE RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3211
Country	:	US
Telephone Number	:	210-495-2000
Fax Number	:	210-495-2001

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	ANDREA CAROLINA VILLARREAL
Credential	:
Telephone Number	:	210-495-2000

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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