=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669848503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL ZINGALIS DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2015
-----------------------------------------------------
Last Update Date | 08/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25135 CALLAWAY
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78260-7255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-656-0572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2250 THOUSAND OAKS DR SUITE #120
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-3989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-314-6635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. MICHAEL ZINGALIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-656-0572
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 20258
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------