MEDICARE: SMILE CENTER DENTAL PA

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

General Provider Information

NPI Number	:	1902042500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE CENTER DENTAL PA

Provider Business Mailing Address
First Line	:	907 S WW WHITE RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-2528
Country	:	US
Telephone Number	:	210-648-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 S WW WHITE RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-2528
Country	:	US
Telephone Number	:	210-648-7600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEPHEN SIMPTON
Credential	:	DDS
Telephone Number	:	210-648-7600

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	01/09/2009

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Directions to “SMILE CENTER DENTAL PA ” Practice Location

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