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General NPI Number Information
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NPI Number | 1073312302
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Entity Type | Organization
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Legal Business Name | ATLANTIC DENTAL GROUP LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 7519 CULEBRA RD # 101
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City | SAN ANTONIO
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State | TX
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Zip | 78251-1501
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Country | US
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Telephone | 816-830-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 3 WALDEN ELMS
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1232
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Country | US
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Telephone | 816-830-6766
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Fax | 210-384-9386
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. KHALED TARBOUSH
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Credential | DDS
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Telephone | 816-830-6766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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