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General NPI Number Information
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NPI Number | 1689463135
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Entity Type | Organization
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Legal Business Name | LIVE OAK ORTHODONTICS PLLC
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 6826 N LOOP 1604 E STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78247-5329
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Country | US
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Telephone | 210-830-7451
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Fax | 210-830-7452
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Provider Business Mailing Address
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Address Line | 6826 N LOOP 1604 E STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78247-5329
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Country | US
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Telephone | 210-830-7451
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Fax | 210-830-7452
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. MOHAMMED ABDULKAREEM ALJAFF
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Credential | DDS, MSD, ABO
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Telephone | 619-365-0206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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