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1396557682 NPI number — SOUTHSIDE FAMILY DENTAL CENTER PC

NPI Number: 1396557682
Health Care Provider/Practitioner: SOUTHSIDE FAMILY DENTAL CENTER PC

Information about “1396557682” NPI (SOUTHSIDE FAMILY DENTAL CENTER PC) exists in 1396557682 in HTML format HTML  |  1396557682 in plain Text format TXT  |  1396557682 in PDF (Portable Document Format) PDF  |  1396557682 in an XML format XML  formats.

NPI Number : 1396557682 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396557682",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "SOUTHSIDE CHILDREN'S DENTAL CENTER, P.C.",
    "ParentOrgTIN": null,
    "OrgName": "SOUTHSIDE FAMILY DENTAL CENTER PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "125 SW MILITARY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN ANTONIO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78221-1650",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "210-921-0314",
    "MailingAddressFaxNumber": "210-610-5887",
    "FirstLinePracticeLocationAddress": "125 SW MILITARY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN ANTONIO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78221-1650",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-921-0314",
    "PracticeLocationAddressFaxNumber": "210-610-5887",
    "EnumerationDate": "01/23/2025",
    "LastUpdateDate": "04/06/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ZERCHER",
    "AuthorizedOfficialFirstName": "DORIS",
    "AuthorizedOfficialMiddleName": "F.",
    "AuthorizedOfficialTitle": "OFFICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "210-862-3506",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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