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General NPI Number Information
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NPI Number | 1457995078
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Entity Type | Organization
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Legal Business Name | PRIMWAY DENTAL, PLLC
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 11345 ALAMO RANCH PKWY STE 202
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City | SAN ANTONIO
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State | TX
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Zip | 78253-6442
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Country | US
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Telephone | 210-688-9190
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Fax |
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Provider Business Mailing Address
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Address Line | 16118 SEEKERS ST
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City | SAN ANTONIO
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State | TX
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Zip | 78255-3311
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Country | US
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Telephone | 210-685-7420
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | ADEPEJU IGUN
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Credential | DDS
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Telephone | 210-685-7420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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