MEDICARE: DENTALWORKS OF SAN ANTONIO P A

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

General Provider Information

NPI Number	:	1518283324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTALWORKS OF SAN ANTONIO P A

Provider Business Mailing Address
First Line	:	5500 MARYLAND WAY STE 120
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 LONE STAR PASS, BLDG 46
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78264-3650
Country	:	US
Telephone Number	:	210-263-5700
Fax Number	:	210-263-5701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ULISES DELACRUZ
Credential	:	DDS
Telephone Number	:	210-263-5700

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	07/24/2020

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