Healthcare Provider Details

I. General information

NPI: 1659989515
Provider Name (Legal Business Name): TEXAS FAMILY ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 BANDERA RD STE 122
SAN ANTONIO TX
78250-5616
US

IV. Provider business mailing address

18811 SALADO CYN
SAN ANTONIO TX
78258-1633
US

V. Phone/Fax

Practice location:
  • Phone: 210-256-9767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN VO
Title or Position: OWNER
Credential: DDS
Phone: 210-256-9767