MEDICARE: SPOTLIGHT DENTISTRY, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1366130346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOTLIGHT DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	16535 HUEBNER RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16535 HUEBNER RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1676
Country	:	US
Telephone Number	:	281-701-0336
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WENDY TAYLOR
Credential	:
Telephone Number	:	281-701-0336

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	05/03/2023

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