MEDICARE: SAMMY SMILES

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	1223G0001X	General Practice Dentistry	21582	TX

General Provider Information

NPI Number	:	1164602991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMMY SMILES

Provider Business Mailing Address
First Line	:	10730 POTRANCO RD STE 111
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3330
Country	:	US
Telephone Number	:	210-509-8400
Fax Number	:	210-509-8404

Provider Business Practice Location Address
First Line	:	10730 POTRANCO RD STE 111
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3330
Country	:	US
Telephone Number	:	210-509-8400
Fax Number	:	210-509-8404

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MRS. LEAH SALTZMAN
Credential	:
Telephone Number	:	210-509-8400

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	11/08/2007

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Directions to “SAMMY SMILES ” Practice Location

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