Healthcare Provider Details

I. General information

NPI: 1003035585
Provider Name (Legal Business Name): J.PERRY FIKES D.D.S P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N LOOP 1604 E SUITE 205
SAN ANTONIO TX
78232-1258
US

IV. Provider business mailing address

400 N LOOP 1604 E SUITE 205
SAN ANTONIO TX
78232-1258
US

V. Phone/Fax

Practice location:
  • Phone: 210-496-3869
  • Fax:
Mailing address:
  • Phone: 210-496-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13610
License Number StateTX

VIII. Authorized Official

Name: J. PERRY FIKES
Title or Position: OWNER
Credential: D.D.S.
Phone: 210-496-3869