Healthcare Provider Details

I. General information

NPI: 1275946857
Provider Name (Legal Business Name): APRIL MOUTON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 KATHERINE WAY
SAN ANTONIO TX
78253-4501
US

IV. Provider business mailing address

156 KATHERINE WAY
SAN ANTONIO TX
78253-4501
US

V. Phone/Fax

Practice location:
  • Phone: 210-313-2048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12679
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: