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General NPI Number Information
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NPI Number | 1740127638
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Entity Type | Organization
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Legal Business Name | GERONIMO CANYON DENTISTRY, PC
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 15489 CULEBRA RD STE 201
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4602
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Country | US
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Telephone | 210-512-1690
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Fax | 210-501-1686
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Provider Business Mailing Address
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Address Line | PO BOX 660041
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City | DALLAS
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State | TX
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Zip | 75266-0041
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Country | US
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Telephone | 714-845-8890
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Fax | 303-952-0892
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTO A BENAVIDES
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Credential | DDS
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Telephone | 210-512-1690
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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 |
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License Number State |
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