Healthcare Provider Details

I. General information

NPI: 1932482676
Provider Name (Legal Business Name): YOLANDA ALLEN, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 VANCE JACKSON # 501
SAN ANTONIO TX
78213
US

IV. Provider business mailing address

14278 SAVANNAH PASS
SAN ANTONIO TX
78216-7849
US

V. Phone/Fax

Practice location:
  • Phone: 210-736-3420
  • Fax:
Mailing address:
  • Phone: 210-383-7108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number23020
License Number StateTX

VIII. Authorized Official

Name: DR. YOLANDA ALLEN
Title or Position: OWNER
Credential: DDS
Phone: 210-383-7108