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NPI Code Detail

MEDICARE: DR. OLIVIA CLAIRE BUSTOS DDS

MEDICARE: DR. OLIVIA CLAIRE BUSTOS DDS
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
1122300000XDentist28255TX

General Provider Information

NPI Number : 1477809861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OLIVIA CLAIRE BUSTOS DDS
Provider Business Mailing Address
First Line : 5983 BANDERA RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78238-1822
Country : US
Telephone Number : 214-226-2732
Fax Number :
Provider Business Practice Location Address
First Line : 5983 BANDERA RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78238-1822
Country : US
Telephone Number : 214-226-2732
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2012
Last Update Date : 10/13/2014

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Directions to “ DR. OLIVIA CLAIRE BUSTOS DDS” Practice Location

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