Healthcare Provider Details

I. General information

NPI: 1730116450
Provider Name (Legal Business Name): LINA M. CARDENAS DDS, MS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINA M. CARDENAS-DENTCHEV DDS

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD STE 400
SAN ANTONIO TX
78211-3793
US

IV. Provider business mailing address

PO BOX 29732
SAN ANTONIO TX
78229-0732
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-8770
  • Fax:
Mailing address:
  • Phone: 210-380-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number21471
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: