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General NPI Number Information
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NPI Number | 1649508789
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Entity Type | Organization
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Legal Business Name | WALZEM FAMILY DENTTAL
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 907 S WW WHITE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78220-2528
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Country | US
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Telephone | 210-648-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 5402 WALZEM RD
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City | SAN ANTONIO
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State | TX
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Zip | 78218-2125
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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 | OWNER
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Name | MR. STEPHEN SIMPTON
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Credential | DDS
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Telephone | 210-837-9056
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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 | 21340
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License Number State | TX
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