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General NPI Number Information
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NPI Number | 1972863314
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Entity Type | Organization
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Legal Business Name | DENTAL DENTAL PLLC
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Dates
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Enumeration Date | 05/19/2012
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Last Update Date | 01/19/2013
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Provider Practice Location Address
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Address Line | 11535 WEST AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78213-1343
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Country | US
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Telephone | 210-366-0100
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Fax | 210-366-0103
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Provider Business Mailing Address
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Address Line | 11535 WEST AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78213-1343
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Country | US
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Telephone | 210-366-0100
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Fax | 210-366-0103
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEDHAT G BADER
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Credential | D.D.S.
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Telephone | 210-366-0100
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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 | 23703
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License Number State | TX
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