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General NPI Number Information
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NPI Number | 1982931564
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Entity Type | Organization
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Legal Business Name | LEMON TREE DENTAL - CANYON GOLF, PLLC
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 26112 OVERLOOK PKWY STE. 1108
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City | SAN ANTONIO
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State | TX
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Zip | 78260
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Country | US
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Telephone | 210-520-3400
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Fax | 210-520-3424
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Provider Business Mailing Address
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Address Line | 6989 ALAMO DOWNS PKWY
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City | SAN ANTONIO
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State | TX
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Zip | 78238-4522
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Country | US
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Telephone | 210-520-3400
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Fax | 210-520-3424
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Authorized Official
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Title or Position | INSURANCE BILLING/COLLECTIONS
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Name | WENDY L HICKEY
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Credential |
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Telephone | 210-520-3400
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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 | 22472
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License Number State | TX
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