MEDICARE: UNDER THE SEA CHILDREN'S DENTISTRY, P.C

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
1	1223P0221X	Pediatric Dentistry	25587	TX

General Provider Information

NPI Number	:	1073947461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNDER THE SEA CHILDREN'S DENTISTRY, P.C

Provider Business Mailing Address
First Line	:	24015 BRIARBROOK WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2686
Country	:	US
Telephone Number	:	210-314-1830
Fax Number	:	210-314-1830

Provider Business Practice Location Address
First Line	:	8340 FM 78
Second Line	:	SUITE #8
City	:	CONVERSE
State	:	TX
Zip	:	78109-1080
Country	:	US
Telephone Number	:	210-314-1830
Fax Number	:	210-314-1830

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. NATASCHA ELENA ARISMENDI SARABIA
Credential	:	DDS
Telephone Number	:	210-862-6458

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/22/2013

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