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General NPI Number Information
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NPI Number | 1538530589
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Entity Type | Organization
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Legal Business Name | ALAMO HEIGHTS DENTISTRY FOR CHILDREN, PLLC
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 8700 CROWNHILL BLVD SUITE #210
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1136
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Country | US
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Telephone | 210-632-4560
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Fax |
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Provider Business Mailing Address
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Address Line | 12016 EUCALYPTUS ST
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City | SAN ANTONIO
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State | TX
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Zip | 78245-3307
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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 | MANAGING MEMBER
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | TX
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