MEDICARE: VALUDENTAL COMMERCE 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	29060	TX

General Provider Information

NPI Number	:	1356798243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALUDENTAL COMMERCE PLLC

Provider Business Mailing Address
First Line	:	21510 PEARL SPG
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-6904
Country	:	US
Telephone Number	:	210-503-0000
Fax Number	:	281-533-6130

Provider Business Practice Location Address
First Line	:	4965 W COMMERCE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-1508
Country	:	US
Telephone Number	:	210-451-0000
Fax Number	:	281-503-0000

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. SETH HUISH
Credential	:	DMD
Telephone Number	:	210-503-0000

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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