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General NPI Number Information
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NPI Number | 1255348926
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Entity Type | Organization
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Legal Business Name | M M ORTHODONTICS PA
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 4422 DE ZAVALA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2013
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Country | US
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Telephone | 210-696-3001
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Fax | 210-764-1989
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Provider Business Mailing Address
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Address Line | 4422 DE ZAVALA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2013
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Country | US
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Telephone | 210-696-3001
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Fax | 210-764-1989
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. DIANA T MALONE
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Credential | D.D.S.,M.S.
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Telephone | 210-696-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 21086
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 20402
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License Number State | TX
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