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General NPI Number Information
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NPI Number | 1972726263
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Entity Type | Organization
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Legal Business Name | ROOT CANAL SPECIALISTS
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 1314 E SONTERRA BLVD STE 301
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4278
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Country | US
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Telephone | 210-495-6710
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Fax | 210-490-8197
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Provider Business Mailing Address
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Address Line | 1314 E SONTERRA BLVD STE 301
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4278
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Country | US
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Telephone | 210-495-6710
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Fax | 210-490-8197
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Authorized Official
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Title or Position | PRESIDENT
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Name | PARVIN DINYARIAN
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Credential | DDS PA
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Telephone | 210-495-6710
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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 | 16180
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License Number State | TX
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