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General NPI Number Information
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NPI Number | 1417006065
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Entity Type | Organization
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Legal Business Name | ALAMO MAXILLOFACIAL SURGICAL ASSOCIATES, PA
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 4499 MEDICAL DR SUITE #190
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3735
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Country | US
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Telephone | 210-614-3915
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Fax | 210-614-3918
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Provider Business Mailing Address
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Address Line | 4499 MEDICAL DR SUITE #190
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3735
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Country | US
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Telephone | 210-614-3915
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Fax | 210-614-3918
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. KELLY ANN SHY
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Credential | MHSM
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Telephone | 210-614-3915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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