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General NPI Number Information
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NPI Number | 1861604753
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Entity Type | Organization
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Legal Business Name | THE INSTITUTE OF ESTHETIC DENTISTRY, LLP
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4455 MEDICAL DRIVE SUITE A
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-692-0153
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Fax | 210-692-0160
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Provider Business Mailing Address
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Address Line | 4455 MEDICAL DRIVE SUITE A
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-692-0153
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Fax | 210-692-0160
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SIMONA CUEVAS
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Credential | D.D.S.
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Telephone | 210-692-0153
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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 | 18102
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License Number State | TX
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