Healthcare Provider Details

I. General information

NPI: 1457138877
Provider Name (Legal Business Name): SANDRA NAIROOZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 N LOOP 1604 E STE 101
SAN ANTONIO TX
78232-1718
US

IV. Provider business mailing address

21319 BEAVER BRK
SAN ANTONIO TX
78260-4893
US

V. Phone/Fax

Practice location:
  • Phone: 210-905-9000
  • Fax:
Mailing address:
  • Phone: 714-299-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA NAIROOZ
Title or Position: OWNER ORTHODONTIST
Credential: DDS
Phone: 210-905-9000