Healthcare Provider Details

I. General information

NPI: 1346402542
Provider Name (Legal Business Name): SANDRA LOUISE DAVILA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 06/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

727 PEABODY AVE
SAN ANTONIO TX
78211-2837
US

V. Phone/Fax

Practice location:
  • Phone: 210-949-8900
  • Fax:
Mailing address:
  • Phone: 210-923-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number15088
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: