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General NPI Number Information
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NPI Number | 1306173554
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Entity Type | Organization
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Legal Business Name | CASTLE HILLS FAMILY DENTAL
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 1931 NW MILITARY HWY SUITE 225
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2153
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Country | US
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Telephone | 210-732-4570
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Fax | 210-732-4572
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Provider Business Mailing Address
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Address Line | 1931 NW MILITARY HWY SUITE 225
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2153
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Country | US
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Telephone | 210-732-4570
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Fax | 210-732-4572
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. RAFAEL LUIS MERCADO
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Credential | D.D.S
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Telephone | 210-732-4570
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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 | 17101
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License Number State | TX
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