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General NPI Number Information
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NPI Number | 1295344679
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Entity Type | Organization
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Legal Business Name | BULVERDE DENTAL SPECIALIST PLLC
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 22103 BULVERDE RD STE 108
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City | SAN ANTONIO
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State | TX
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Zip | 78259-1855
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Country | US
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Telephone | 210-907-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 22103 BULVERDE RD STE 108
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City | SAN ANTONIO
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State | TX
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Zip | 78259-1855
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATING MEMBER
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Name | YUNHAN DING
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Credential | DDS
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Telephone | 210-867-7489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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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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