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General NPI Number Information
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NPI Number | 1316778772
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Entity Type | Organization
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Legal Business Name | ORBIS DENTAL GROUP PLLC
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Dates
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Enumeration Date | 08/08/2024
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 17201 SAN PEDRO AVE # 130
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1403
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Country | US
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Telephone | 210-496-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 FAWN HVN
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City | SAN ANTONIO
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State | TX
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Zip | 78248-1738
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Country | US
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Telephone | 978-809-9960
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AUSTIN LEE
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Credential | DMD
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Telephone | 978-809-9960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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