MEDICARE: DR. EMANUEL FLORIAN DEHELEAN DMD

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	122300000X	Dentist	0022549	TX
2	1223G0001X	General Practice Dentistry	0022549	TX

General Provider Information

NPI Number	:	1073589131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMANUEL FLORIAN DEHELEAN DMD

Provider Business Mailing Address
First Line	:	4719 CAMINO DORADO DR
Second Line	:	STE 2
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-6357
Country	:	US
Telephone Number	:	210-656-4699
Fax Number	:	210-656-4699

Provider Business Practice Location Address
First Line	:	MASON DENTAL CENTER
Second Line	:	4455 HARRY WURZBACH
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209
Country	:	US
Telephone Number	:	210-822-4664
Fax Number	:	210-822-4878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	04/08/2016

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