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General NPI Number Information
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NPI Number | 1598310344
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Entity Type | Organization
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Legal Business Name | CELEBRACES SE MILITARY PLLC
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 3611 SE MILITARY DRIVE SUITE B101
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City | SAN ANTONIO
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State | TX
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Zip | 78223
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Country | US
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Telephone | 210-404-4504
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Fax |
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Provider Business Mailing Address
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Address Line | 3611 SE MILITARY DRIVE SUITE B101
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City | SAN ANTONIO
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State | TX
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Zip | 78223
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Country | US
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Telephone | 210-404-4504
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. DAVID B FERGUSON
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Credential | DDS,CAGS
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Telephone | 210-404-4450
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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 |
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