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General NPI Number Information
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NPI Number | 1518283324
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Entity Type | Organization
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Legal Business Name | DENTALWORKS OF SAN ANTONIO P A
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 1 LONE STAR PASS, BLDG 46
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City | SAN ANTONIO
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State | TX
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Zip | 78264-3650
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Country | US
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Telephone | 210-263-5700
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Fax | 210-263-5701
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Provider Business Mailing Address
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Address Line | 5500 MARYLAND WAY STE 120
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City | BRENTWOOD
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State | TN
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Zip | 37027-4993
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ULISES DELACRUZ
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Credential | DDS
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Telephone | 210-263-5700
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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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