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General NPI Number Information
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NPI Number | 1144604166
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Entity Type | Organization
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Legal Business Name | WEST CULEBRA DENTAL PLLC
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 5835 CULEBRA RD SUITE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78228-4354
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Country | US
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Telephone | 940-368-1495
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 TEASLEY LN
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City | DENTON
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State | TX
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Zip | 76205-7946
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Country | US
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Telephone | 254-717-8469
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. DARREN EARL BOGGS
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Credential |
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Telephone | 940-368-1495
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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 | 26562
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License Number State | TX
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