MEDICARE: CASSANDRA ELKINS DDS, 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
1	1223P0221X	Pediatric Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104394816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSANDRA ELKINS DDS, PLLC

Provider Business Mailing Address
First Line	:	18330 GRAN MESA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2436
Country	:	US
Telephone Number	:	210-289-8621
Fax Number	:	210-694-5066

Provider Business Practice Location Address
First Line	:	9543 HUEBNER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1510
Country	:	US
Telephone Number	:	210-268-0414
Fax Number	:	210-694-5066

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CASSANDRA J ELKINS
Credential	:	DDS
Telephone Number	:	210-268-0414

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	11/12/2018

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