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General NPI Number Information
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NPI Number | 1710877006
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Entity Type | Organization
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Legal Business Name | ONE DESTINATION CLINIC SAN ANTONIO, LLC
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 3402 S GEVERS ST
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City | SAN ANTONIO
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State | TX
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Zip | 78210-5414
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Country | US
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Telephone | 210-533-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 3402 S GEVERS ST
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City | SAN ANTONIO
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State | TX
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Zip | 78210-5414
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Country | US
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Telephone | 210-533-6611
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | JOSEPH MILLER
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Credential |
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Telephone | 858-842-7011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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