Healthcare Provider Details

I. General information

NPI: 1215436167
Provider Name (Legal Business Name): BABCOCK DENTAL PARTNERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 BABCOCK RD STE 1
SAN ANTONIO TX
78249-2345
US

IV. Provider business mailing address

6565 BABCOCK RD STE 1
SAN ANTONIO TX
78249-2345
US

V. Phone/Fax

Practice location:
  • Phone: 210-904-2888
  • Fax:
Mailing address:
  • Phone: 210-904-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KANDICE SCITERN
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 210-904-2888