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General NPI Number Information
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NPI Number | 1366873929
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Entity Type | Organization
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Legal Business Name | ELDER DENT OF TEXAS, PLLC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 20079 STONE OAK PKWY STE 1105-436
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City | SAN ANTONIO
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State | TX
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Zip | 78258-6942
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Country | US
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Telephone | 502-498-0093
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Fax | 210-881-6823
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Provider Business Mailing Address
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Address Line | 20079 STONE OAK PKWY STE 1105-436
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City | SAN ANTONIO
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State | TX
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Zip | 78258-6942
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Country | US
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Telephone | 210-888-0119
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Fax | 210-881-6823
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER DOANE
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Credential | DMD
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Telephone | 502-498-0093
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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 | 27592
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License Number State | TX
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