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General NPI Number Information
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NPI Number | 1164602991
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Entity Type | Organization
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Legal Business Name | SAMMY SMILES
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 10730 POTRANCO RD STE 111
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3330
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Country | US
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Telephone | 210-509-8400
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Fax | 210-509-8404
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Provider Business Mailing Address
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Address Line | 10730 POTRANCO RD STE 111
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3330
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Country | US
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Telephone | 210-509-8400
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Fax | 210-509-8404
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. LEAH SALTZMAN
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Credential |
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Telephone | 210-509-8400
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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 | 21582
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License Number State | TX
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