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General NPI Number Information
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NPI Number | 1336485010
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Entity Type | Organization
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Legal Business Name | GROWING SMILES PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 10722 POTRANCO RD SUITE 109
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3314
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Country | US
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Telephone | 210-307-7709
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Fax |
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Provider Business Mailing Address
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Address Line | 10722 POTRANCO RD SUITE 109
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3314
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Country | US
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Telephone | 210-307-7709
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. EDUARDO PEREZ JR.
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Credential | DDS
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Telephone | 210-307-7709
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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 | 20174
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License Number State | TX
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