=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093367120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN LOTH KAUFFMAN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2019
-----------------------------------------------------
Last Update Date | 07/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20821 US HIGHWAY 281 N STE 310
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-7597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-494-4488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20821 US HIGHWAY 281 N STE 310
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-7597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-494-4488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 35394
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------