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General NPI Number Information
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NPI Number | 1841714672
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO ENDODONTICS ASSOCIATES LLC
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 1110 NW LOOP 410 SUITE 515
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City | SAN ANTONIO
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State | TX
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Zip | 78213
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Country | US
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Telephone | 210-341-8281
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Fax | 210-341-8282
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Provider Business Mailing Address
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Address Line | 1100 NW LOOP 410 STE 515
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2259
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Country | US
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Telephone | 210-341-8281
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Fax | 210-341-8282
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | DAVID LEO CLOUTIER
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Credential | DMD
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Telephone | 210-341-8281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 26412
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License Number State | TX
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