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General NPI Number Information
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NPI Number | 1982964839
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Entity Type | Organization
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Legal Business Name | WINDCREST PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 5500 WALZEM RD
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City | SAN ANTONIO
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State | TX
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Zip | 78218-2103
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Country | US
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Telephone | 210-657-4641
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Fax | 210-655-4012
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Provider Business Mailing Address
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Address Line | 5500 WALZEM RD
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City | SAN ANTONIO
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State | TX
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Zip | 78218-2103
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Country | US
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Telephone | 210-657-4641
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Fax | 210-655-4012
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Authorized Official
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Title or Position | OWNER
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Name | SYLVESTER C. AWAGU
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Credential | DMD
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Telephone | 210-657-4641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 24209
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License Number State | TX
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