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General NPI Number Information
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NPI Number | 1902815335
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE CHILDREN'S DENTAL CENTER, P.C.
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 125 SW MILITARY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1650
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Country | US
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Telephone | 210-922-3483
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Fax | 210-922-8902
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Provider Business Mailing Address
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Address Line | 125 SW MILITARY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1650
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Country | US
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Telephone | 210-922-3483
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Fax | 210-922-8902
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DORIS CODERRE-ZERCHER
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Credential |
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Telephone | 210-922-3483
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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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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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