MEDICARE: MISS BEATRIZ CANTU-PETTY D.D.S.

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	19379	TX

General Provider Information

NPI Number	:	1386809226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BEATRIZ CANTU-PETTY D.D.S.

Provider Business Mailing Address
First Line	:	2358 E SOUTHCROSS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-2263
Country	:	US
Telephone Number	:	210-532-9998
Fax Number	:	210-532-9992

Provider Business Practice Location Address
First Line	:	9262 CULEBRA RD
Second Line	:	107
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3571
Country	:	US
Telephone Number	:	210-680-0860
Fax Number	:	210-680-0861

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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