Healthcare Provider Details

I. General information

NPI: 1174929459
Provider Name (Legal Business Name): U TOO DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 ROOSEVELT AVE
SAN ANTONIO TX
78214-2832
US

IV. Provider business mailing address

3543 ROOSEVELT AVE
SAN ANTONIO TX
78214-2832
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-3232
  • Fax: 210-932-2168
Mailing address:
  • Phone: 210-922-3232
  • Fax: 210-932-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT MALONE
Title or Position: OWNER/DOCTOR
Credential: DDS
Phone: 210-922-3232