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General NPI Number Information
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NPI Number | 1407062193
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Entity Type | Organization
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Legal Business Name | ALAMO HEIGHTS PERIODONTICS PC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7231 BROADWAY ST
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3701
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Country | US
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Telephone | 210-822-7002
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Fax | 210-824-1433
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Provider Business Mailing Address
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Address Line | 7231 BROADWAY ST
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3701
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Country | US
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Telephone | 210-822-7002
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Fax | 210-824-1433
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MONICA ALANA FLYNN
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Credential | DMD
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Telephone | 210-822-7002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 20683
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License Number State | TX
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