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General NPI Number Information
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NPI Number | 1538434048
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS CHILDRENS DENTISTRY P.A.
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 408 S GETTY ST
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City | UVALDE
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State | TX
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Zip | 78801-5609
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Country | US
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Telephone | 830-278-5009
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Fax |
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Provider Business Mailing Address
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Address Line | 408 S GETTY ST
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City | UVALDE
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State | TX
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Zip | 78801-5609
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Country | US
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Telephone | 830-278-5009
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR IGUNBOLA
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Credential | D.D.S.
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Telephone | 830-278-5009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 18691
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License Number State | TX
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