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General NPI Number Information
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NPI Number | 1700906518
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO DENTAL ASSOCIATES
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6253 VANCE JACKSON RD
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City | SAN ANTONIO
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State | TX
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Zip | 78230-3347
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Country | US
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Telephone | 210-690-4500
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Fax | 210-690-5835
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Provider Business Mailing Address
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Address Line | 6253 VANCE JACKSON RD
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City | SAN ANTONIO
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State | TX
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Zip | 78230-3347
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Country | US
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Telephone | 210-690-4500
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Fax | 210-690-5835
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH MARYLL FARRIMOND
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Credential | DDS
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Telephone | 210-690-4500
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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 | 7686
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22772
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18998
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License Number State | TX
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