Healthcare Provider Details

I. General information

NPI: 1063643435
Provider Name (Legal Business Name): AIYANA CHASE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 POTEET JOURDANTON FWY
SAN ANTONIO TX
78224-2124
US

IV. Provider business mailing address

3750 COMMERCIAL AVE
SAN ANTONIO TX
78221-3117
US

V. Phone/Fax

Practice location:
  • Phone: 210-921-6010
  • Fax: 210-921-6188
Mailing address:
  • Phone: 210-334-3750
  • Fax: 210-922-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0024798
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: