Healthcare Provider Details

I. General information

NPI: 1306970033
Provider Name (Legal Business Name): JOHN A JUNGHANS DDS,PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 SHERWOOD DR
SAN ANTONIO TX
78201-2815
US

IV. Provider business mailing address

13642 PRINCES KNLS
SAN ANTONIO TX
78231-1947
US

V. Phone/Fax

Practice location:
  • Phone: 210-336-8873
  • Fax: 210-336-8873
Mailing address:
  • Phone: 210-535-4348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16149
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: