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General NPI Number Information
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NPI Number | 1376370791
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Entity Type | Organization
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Legal Business Name | TLG DENTAL GROUP
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 3293 WURZBACH RD # 103
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City | SAN ANTONIO
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State | TX
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Zip | 78238-4002
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Country | US
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Telephone | 661-808-0181
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Fax |
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Provider Business Mailing Address
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Address Line | 430 PUEBLO PINTADO
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City | HELOTES
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State | TX
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Zip | 78023-4725
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Country | US
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Telephone | 661-808-0181
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | TAOUFIK FADDOUL
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Credential | DDS
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Telephone | 661-808-0181
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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 |
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License Number State |
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