Healthcare Provider Details

I. General information

NPI: 1124107495
Provider Name (Legal Business Name): ALVIN J ELSIK JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N RIO GRANDE
SAN ANTONIO TX
78202-3265
US

IV. Provider business mailing address

332 W COMMERCE ST
SAN ANTONIO TX
78205-2409
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-9035
  • Fax: 210-924-6273
Mailing address:
  • Phone: 210-924-9035
  • Fax: 210-924-6273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number10693
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: