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General NPI Number Information
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NPI Number | 1578045159
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Entity Type | Individual
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Provider Name | CARLOS ALONSO BERNAL DDS
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Gender | Male
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 327 NW LOOP 410 STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78216-5304
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Country | US
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Telephone | 844-776-4802
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Fax |
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Provider Business Mailing Address
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Address Line | 410 E EVERGREEN ST APT A
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4422
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Country | US
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Telephone | 817-996-9142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 34486
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License Number State | TX
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