Healthcare Provider Details

I. General information

NPI: 1598099541
Provider Name (Legal Business Name): SOUTH TEXAS SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10007 HUEBNER RD STE 103
SAN ANTONIO TX
78240-1646
US

IV. Provider business mailing address

10007 HUEBNER RD STE 103
SAN ANTONIO TX
78240-1646
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-3898
  • Fax: 210-614-3950
Mailing address:
  • Phone: 210-614-3898
  • Fax: 210-614-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8261
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4540
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12877
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13272
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22977
License Number StateTX

VIII. Authorized Official

Name: DR. ANA MALDONADO
Title or Position: OWNER
Credential: DMD
Phone: 210-614-3898