MEDICARE: DR. JENNA-LEIGH ABBOTT DMD

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	36149	TX

General Provider Information

NPI Number	:	1215551635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA-LEIGH ABBOTT DMD

Provider Business Mailing Address
First Line	:	2714 WEST AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 DE ZAVALA RD STE 225
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1731
Country	:	US
Telephone Number	:	210-696-0667
Fax Number	:	210-696-2727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	06/01/2020

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