MEDICARE: HERITAGE DENTAL

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	:	1255765863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE DENTAL

Provider Business Mailing Address
First Line	:	9590 MARBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1825
Country	:	US
Telephone Number	:	210-673-9051
Fax Number	:	210-673-9053

Provider Business Practice Location Address
First Line	:	9590 MARBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1825
Country	:	US
Telephone Number	:	210-673-9051
Fax Number	:	210-673-9053

Authorized Official
Title or Position	:	DENTIST, OWNER
Name	:	HUMAM ALNAJJAR
Credential	:	DDS
Telephone Number	:	210-673-9051

Provider Enumeration Date	:	08/30/2013
Last Update Date	:	08/30/2013

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Directions to “HERITAGE DENTAL ” Practice Location

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