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General NPI Number Information
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NPI Number | 1093198186
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Entity Type | Organization
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Legal Business Name | NORTH BABCOCK DENTAL PLLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 5970 BABCOCK RD.
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City | SAN ANTONIO
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State | TX
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Zip | 78240
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Country | US
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Telephone | 210-625-5993
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Fax |
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Provider Business Mailing Address
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Address Line | 5970 BABCOCK RD
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City | SAN ANTONIO
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State | TX
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Zip | 78240
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Country | US
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Telephone | 210-625-5993
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MR. OTTO L. HEROD
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Credential | D.D.S., P.A.
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Telephone | 210-328-2013
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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 | 22178
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25595
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License Number State | TX
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Taxonomy #3
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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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