Healthcare Provider Details

I. General information

NPI: 1740877877
Provider Name (Legal Business Name): SNA DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13037 NACOGDOCHES RD
SAN ANTONIO TX
78217-1960
US

IV. Provider business mailing address

13037 NACOGDOCHES RD
SAN ANTONIO TX
78217-1960
US

V. Phone/Fax

Practice location:
  • Phone: 210-654-8109
  • Fax:
Mailing address:
  • Phone: 781-502-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VAIDEHI MEHTA
Title or Position: MANAGING PARTNER
Credential: DMD
Phone: 781-502-8731