MEDICARE: SOUTHSIDE FAMILY DENTAL CENTER PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1396557682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE FAMILY DENTAL CENTER PC

Provider Business Mailing Address
First Line	:	125 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1650
Country	:	US
Telephone Number	:	210-921-0314
Fax Number	:	210-610-5887

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	:	210-921-0314
Fax Number	:	210-610-5887

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DORIS F. ZERCHER
Credential	:
Telephone Number	:	210-862-3506

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	04/06/2026

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