MEDICARE: ALAMO KIDS DENTAL PLLC

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	1223P0221X	Pediatric Dentistry		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982104139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMO KIDS DENTAL PLLC

Provider Business Mailing Address
First Line	:	6820 ALAMO PKWY STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6595
Country	:	US
Telephone Number	:	210-951-0046
Fax Number	:	210-688-4418

Provider Business Practice Location Address
First Line	:	6820 ALAMO PKWY STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6595
Country	:	US
Telephone Number	:	210-951-0046
Fax Number	:	210-688-4418

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	DR. PETER GURR
Credential	:	DDS
Telephone Number	:	210-951-0046

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	02/14/2018

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Directions to “ALAMO KIDS DENTAL PLLC ” Practice Location

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