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General NPI Number Information
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NPI Number | 1366643496
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Entity Type | Organization
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Legal Business Name | SAN PEDRO DENTAL ASSOCIATES, PC
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 16414 SAN PEDRO AVE #200
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City | SAN ANTONIO
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State | TX
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Zip | 78232-2277
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Country | US
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Telephone | 210-499-0009
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Fax | 210-499-0002
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Provider Business Mailing Address
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Address Line | 16414 SAN PEDRO AVE #200
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City | SAN ANTONIO
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State | TX
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Zip | 78232-2277
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Country | US
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Telephone | 210-499-0009
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Fax | 210-499-0002
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MRS. EDIE DUTTON
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Credential |
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Telephone | 830-981-9193
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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 | 17072
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License Number State | TX
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