MEDICARE: DR. ANAS ATHAR

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	1223X0008X	Oral and Maxillofacial Radiology Dentistry	25953	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	25953	TX

General Provider Information

NPI Number	:	1215244330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANAS ATHAR

Provider Business Mailing Address
First Line	:	1218 SW MILITARY DRIVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221
Country	:	US
Telephone Number	:	210-533-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 S NEW BRAUNFELS AVE STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1710
Country	:	US
Telephone Number	:	210-533-9900
Fax Number	:

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

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	01/18/2011

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