Healthcare Provider Details

I. General information

NPI: 1063832558
Provider Name (Legal Business Name): WESTOVER HILLS FAMILY DENTAL CARE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 STATE HIGHWAY 151 STE # 290
SAN ANTONIO TX
78251-4498
US

IV. Provider business mailing address

11212 STATE HIGHWAY 151 STE # 290
SAN ANTONIO TX
78251-4498
US

V. Phone/Fax

Practice location:
  • Phone: 210-257-0953
  • Fax:
Mailing address:
  • Phone: 210-257-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17028
License Number StateTX

VIII. Authorized Official

Name: MS. JOLYNN ZAMORA
Title or Position: INS COORD
Credential:
Phone: 210-927-1400