MEDICARE: AIM SP DENTAL 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588250906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIM SP DENTAL PLLC

Provider Business Mailing Address
First Line	:	14500 SAN PEDRO AVE STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4354
Country	:	US
Telephone Number	:	210-494-7300
Fax Number	:	210-494-6842

Provider Business Practice Location Address
First Line	:	14500 SAN PEDRO AVE STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4354
Country	:	US
Telephone Number	:	210-494-7300
Fax Number	:	210-494-6842

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MUSTAFA IQBAL
Credential	:	DDS
Telephone Number	:	210-215-9663

Provider Enumeration Date	:	12/20/2020
Last Update Date	:	12/20/2020

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Directions to “AIM SP DENTAL PLLC ” Practice Location

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