Healthcare Provider Details

I. General information

NPI: 1487715827
Provider Name (Legal Business Name): THOMAS R URIBE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 S GEN MCMULLEN, SUITE 102
SAN ANTONIO TX
78237
US

IV. Provider business mailing address

1302 S GEN MCMULLEN, SUITE 102
SAN ANTONIO TX
78237
US

V. Phone/Fax

Practice location:
  • Phone: 210-432-7851
  • Fax: 210-432-1157
Mailing address:
  • Phone: 210-432-7851
  • Fax: 210-432-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9989
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: