MEDICARE: AAAA 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	122300000X	Dentist	16538	TX

General Provider Information

NPI Number	:	1396089496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AAAA DENTAL

Provider Business Mailing Address
First Line	:	3233 WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-4002
Country	:	US
Telephone Number	:	210-680-6325
Fax Number	:	210-680-4957

Provider Business Practice Location Address
First Line	:	3233 WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-4002
Country	:	US
Telephone Number	:	210-680-6325
Fax Number	:	210-680-4957

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SIXTO SAN MIGUEL JR.
Credential	:
Telephone Number	:	210-680-6325

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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