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General NPI Number Information
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NPI Number | 1497640023
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Entity Type | Organization
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Legal Business Name | SMILE KINGS OF SA, PLLC
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 919 BANDERA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1503
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Country | US
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Telephone | 210-774-6186
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 356
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City | LYTLE
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State | TX
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Zip | 78052-0356
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Country | US
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Telephone | 210-632-4560
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOANNA AYALA
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Credential |
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Telephone | 210-632-4560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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