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General NPI Number Information
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NPI Number | 1760987168
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Entity Type | Organization
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Legal Business Name | JOSE ENRIQUE AREVALO DDS, PLLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 1730 SW MILITARY DR STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1400
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Country | US
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Telephone | 951-250-5812
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 SW MILITARY DR STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1400
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Country | US
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Telephone | 210-410-2452
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE ENRIQUE AREVALO
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Credential | DDS
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Telephone | 951-250-5812
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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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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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