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General NPI Number Information
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NPI Number | 1073248969
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Entity Type | Individual
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Provider Name | ANDREA LACERDA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2022
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 20711 WILDERNESS OAK STE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78258-2641
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Country | US
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Telephone | 210-787-1200
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Fax | 210-497-6077
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Provider Business Mailing Address
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Address Line | 2911 ZURICH
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City | SAN ANTONIO
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State | TX
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Zip | 78230-2883
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Country | US
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Telephone | 860-416-7497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 41037
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License Number State | TX
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