Healthcare Provider Details

I. General information

NPI: 1992990139
Provider Name (Legal Business Name): BEXAR COUNTY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 SW MILITARY DR
SAN ANTONIO TX
78221-1636
US

IV. Provider business mailing address

529 SW MILITARY DR
SAN ANTONIO TX
78221-1636
US

V. Phone/Fax

Practice location:
  • Phone: 210-435-6090
  • Fax: 210-435-7722
Mailing address:
  • Phone: 210-435-6090
  • Fax: 210-435-7722

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: MRS. ABBY SIMPTON
Title or Position: OWNER
Credential:
Phone: 512-507-8107