MEDICARE: ALAMO DENTIST,PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1174799753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMO DENTIST,PC

Provider Business Mailing Address
First Line	:	2339 E EVANS RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2339 E EVANS RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2718
Country	:	US
Telephone Number	:	210-490-6900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIVIAN V MAI
Credential	:	D.M.D.
Telephone Number	:	210-490-6900

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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