=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447473277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOUSAND OAKS CHILDREN'S DENTISTRY, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2235 THOUSAND OAKS DR SUITE 122
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-3966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-490-1133
-----------------------------------------------------
Fax | 210-490-6028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2235 THOUSAND OAKS DR SUITE 122
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-3966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-490-1133
-----------------------------------------------------
Fax | 210-490-6028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. JAMES MICHAEL DOOSE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 210-490-1133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 18666
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------