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General NPI Number Information
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NPI Number | 1013106731
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Entity Type | Organization
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Legal Business Name | ATIQUE ORTHODONTICS, P.A.
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 2770 E EVANS RD SUITE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78259-2752
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Country | US
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Telephone | 210-497-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 340 TREELINE PARK # 1229
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1888
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Country | US
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Telephone | 210-826-7422
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA ISABEL ATIQUE
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Credential | DDS
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Telephone | 210-497-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22352
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License Number State | TX
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