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General NPI Number Information
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NPI Number | 1841056058
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Entity Type | Individual
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Provider Name | TATIANNA ALEXIS MCKISSICK DDS
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Gender | Female
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 7970 FREDERICKSBURG RD STE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3891
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Country | US
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Telephone | 210-248-0381
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Fax |
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Provider Business Mailing Address
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Address Line | 7970 FREDERICKSBURG RD STE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3891
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Country | US
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Telephone | 210-248-0381
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 42045
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License Number State | TX
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