Healthcare Provider Details

I. General information

NPI: 1255350435
Provider Name (Legal Business Name): WESTSIDE PEDIATRIC DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7322 MILITARY DRIVE WEST
SAN ANTONIO TX
78227-2924
US

IV. Provider business mailing address

7322 MILITARY DRIVE WEST
SAN ANTONIO TX
78227-2924
US

V. Phone/Fax

Practice location:
  • Phone: 210-673-3792
  • Fax: 210-673-8837
Mailing address:
  • Phone: 210-673-3792
  • Fax: 210-673-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BRETT H MUELLER
Title or Position: PRESIDENT OWNER
Credential: DDS MA
Phone: 210-673-3792