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General NPI Number Information
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NPI Number | 1437481876
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Entity Type | Organization
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Legal Business Name | ADVANCED ENDODONTIC SPECIALISTS
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 335 E SONTERRA BLVD STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4071
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Country | US
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Telephone | 360-434-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 335 E SONTERRA BLVD STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4071
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Country | US
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Telephone | 360-434-3636
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST/OWNER
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Name | DR. GISELLE CARDENAS EITTER
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Credential | DDS,MSD
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Telephone | 360-434-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 602990076
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License Number State | WA
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