MEDICARE: AFFORDABLE DENTURES & IMPLANTS - TEXAS IX, 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

General Provider Information

NPI Number	:	1538908280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES & IMPLANTS - TEXAS IX, PLLC

Provider Business Mailing Address
First Line	:	1432 AUSTIN HWY STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4903
Country	:	US
Telephone Number	:	726-232-8685
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 AUSTIN HWY STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4903
Country	:	US
Telephone Number	:	726-232-8685
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TALYA MINTZ
Credential	:	DDS
Telephone Number	:	726-232-8685

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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