=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558489898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRITTON ORTHODONTICS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1130 E SONTERRA BLVD STE 100
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-497-6688
-----------------------------------------------------
Fax | 210-545-1884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1130 E SONTERRA BLVD STE 100
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-497-6688
-----------------------------------------------------
Fax | 210-545-1884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BLOYCE HILL BRITTON III
-----------------------------------------------------
Credential | DDS MS
-----------------------------------------------------
Telephone | 210-497-6688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 17878
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------