MEDICARE: WESTERN DENTAL CARE

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	:	1487202750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN DENTAL CARE

Provider Business Mailing Address
First Line	:	2347 NW MILITARY HWY STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2502
Country	:	US
Telephone Number	:	210-277-0212
Fax Number	:

Provider Business Practice Location Address
First Line	:	2347 NW MILITARY HWY STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2502
Country	:	US
Telephone Number	:	210-277-0212
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TASNEIM A MOHAMED
Credential	:	DDS
Telephone Number	:	210-277-0212

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/29/2019

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Directions to “WESTERN DENTAL CARE ” Practice Location

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