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General NPI Number Information
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NPI Number | 1942518626
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Entity Type | Organization
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Legal Business Name | DEERFIELD DENTAL
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 14855 BLANCO RD STE 413
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City | SAN ANTONIO
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State | TX
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Zip | 78216-7731
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Country | US
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Telephone | 210-408-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 5999 DE ZAVALA RD STE 122
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2236
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Country | US
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Telephone | 210-408-6000
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Fax | 210-561-2599
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. IRENE KIANSKY BLAESS
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Credential |
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Telephone | 210-445-7915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19006
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License Number State | TX
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