MEDICARE: DR. JASON MAHMALJI 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
1	122300000X	Dentist	25925	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25925	OTHER	TX	DENTAL

General Provider Information

NPI Number	:	1548576085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MAHMALJI DDS

Provider Business Mailing Address
First Line	:	1218 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1535
Country	:	US
Telephone Number	:	210-928-2814
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 FREDERICKSBURG RD STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-1969
Country	:	US
Telephone Number	:	210-734-9551
Fax Number	:

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

Provider Enumeration Date	:	08/22/2010
Last Update Date	:	09/22/2010

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