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General NPI Number Information
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NPI Number | 1457565483
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Entity Type | Organization
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Legal Business Name | ALL ABOUT TEETH
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 14400 JONES MALTSBERGER RD SUITE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78247-3748
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Country | US
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Telephone | 210-545-3929
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Fax | 210-545-5069
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Provider Business Mailing Address
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Address Line | 14400 JONES MALTSBERGER RD SUITE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78247-3748
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Country | US
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Telephone | 210-545-3929
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Fax | 210-545-5069
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLY ROSHARON LANE
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Credential | DDS
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Telephone | 210-545-3929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D 18205
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D 16514
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License Number State | TX
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