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General NPI Number Information
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NPI Number | 1174274021
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Entity Type | Organization
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Legal Business Name | GEORGE ROAD DENTAL PLLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 13205 GEORGE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78230-3018
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Country | US
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Telephone | 210-361-8905
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Fax | 210-492-0305
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Provider Business Mailing Address
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Address Line | 13205 GEORGE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78230-3018
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Country | US
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Telephone | 210-361-8905
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Fax | 210-492-0305
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | FAITH GASKINS
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Credential |
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Telephone | 972-869-3789
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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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