Healthcare Provider Details

I. General information

NPI: 1083796882
Provider Name (Legal Business Name): BEXAR DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 CASTROVILLE RD SUITE 412
SAN ANTONIO TX
78237-3153
US

IV. Provider business mailing address

803 CASTROVILLE RD SUITE 412
SAN ANTONIO TX
78237-3153
US

V. Phone/Fax

Practice location:
  • Phone: 210-435-6090
  • Fax:
Mailing address:
  • Phone: 210-435-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID J. YASSA
Title or Position: BILLING/COLLECTIONS SPECIALIST
Credential: DDS
Phone: 210-771-7327