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NPI Code Detail

MEDICARE: SOUTHSIDE CHILDRENSA DENTAL CENTER

MEDICARE: SOUTHSIDE CHILDRENSA DENTAL CENTER
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
11223P0221XPediatric Dentistry14060TX
21223P0221XPediatric Dentistry23705WI
31223P0221XPediatric Dentistry25239PA
41223X0400XOrthodontics and Dentofacial Orthopedics Dentistry27696CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396174900
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSIDE CHILDRENSA DENTAL CENTER
Provider Business Mailing Address
First Line : 125 SW MILITARY DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78221-1650
Country : US
Telephone Number : 210-922-3483
Fax Number :
Provider Business Practice Location Address
First Line : 125 SW MILITARY DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78221-1650
Country : US
Telephone Number : 210-922-3483
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. DORIS ZERCHER
Credential :
Telephone Number : 210-922-3483
Provider Enumeration Date : 11/04/2013
Last Update Date : 11/04/2013

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Practice Location Address:
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1992763874 — DR. LISA MARGARET ABADEER DDS
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1902815335 — SOUTHSIDE CHILDREN'S DENTAL CENTER, P.C.
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1942460274 — JOSEPH S OLEA DDS PA
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1932464831 — DR. YUSIF MOHAMMAD DDS
Practice Location Address:
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Practice Fax: 210-610-5887

Directions to “SOUTHSIDE CHILDRENSA DENTAL CENTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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