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NPI Code Detail

MEDICARE: VALUDENTAL PLLC

MEDICARE: VALUDENTAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry24904TX
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry24904TX
3122300000XDentist24904TX

General Provider Information

NPI Number : 1003112343
Entity Type Code : Organization
Provider Name (Legal Business Name) : VALUDENTAL PLLC
Provider Business Mailing Address
First Line : 8700 MARBACH RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78227-2345
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8700 MARBACH RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78227-2345
Country : US
Telephone Number : 904-994-0410
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DAVID BURTON FERGUSON
Credential :
Telephone Number : 904-994-0410
Provider Enumeration Date : 02/03/2011
Last Update Date : 02/03/2011

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