MEDICARE: CASTLE HILLS FAMILY 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	17101	TX

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
2	1376774851	OTHER	TX	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306173554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE HILLS FAMILY DENTAL

Provider Business Mailing Address
First Line	:	1931 NW MILITARY HWY
Second Line	:	SUITE 225
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-732-4570
Fax Number	:	210-732-4572

Provider Business Practice Location Address
First Line	:	1931 NW MILITARY HWY
Second Line	:	SUITE 225
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-732-4570
Fax Number	:	210-732-4572

Authorized Official
Title or Position	:	GENERAL DENTIST/OWNER
Name	:	DR. RAFAEL LUIS MERCADO
Credential	:	D.D.S
Telephone Number	:	210-732-4570

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	07/18/2014

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Directions to “CASTLE HILLS FAMILY DENTAL ” Practice Location

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