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General NPI Number Information
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NPI Number | 1518237189
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Entity Type | Organization
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Legal Business Name | LAITH FAMILY DENTRISTRY
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 10865 SHAENFIELD RD SUITE 1108
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City | SAN ANTONIO
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State | TX
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Zip | 78254-9601
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Country | US
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Telephone | 210-782-6842
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Fax | 210-310-3475
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Provider Business Mailing Address
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Address Line | 10865 SHAENFIELD RD SUITE 1108
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City | SAN ANTONIO
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State | TX
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Zip | 78254-9601
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Country | US
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Telephone | 210-782-6842
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Fax | 210-310-3475
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. RACHA W KHIREIWISH
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Credential | DDS
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Telephone | 210-782-6842
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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 | 25079
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License Number State | TX
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