MEDICARE: TOOTHTIME FAMILY DENTISTRY SAN ANTONIO 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	1223G0001X	General Practice Dentistry	19207	TX

General Provider Information

NPI Number	:	1265696082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOOTHTIME FAMILY DENTISTRY SAN ANTONIO PLLC

Provider Business Mailing Address
First Line	:	102 BABCOCK RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3952
Country	:	US
Telephone Number	:	210-731-9400
Fax Number	:	210-731-9449

Provider Business Practice Location Address
First Line	:	102 BABCOCK RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3952
Country	:	US
Telephone Number	:	210-731-9400
Fax Number	:	210-731-9449

Authorized Official
Title or Position	:	DENTIST/ OWNER
Name	:	DR. CHRISTOPHER DAVID WILLIAMS
Credential	:	DDS
Telephone Number	:	830-221-5048

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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