MEDICARE: BEATRIZ CANTU PETTY DDS 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	1223G0001X	General Practice Dentistry	19379	TX

General Provider Information

NPI Number	:	1619186111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEATRIZ CANTU PETTY DDS PC

Provider Business Mailing Address
First Line	:	2358 E SOUTHCROSS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-2263
Country	:	US
Telephone Number	:	210-532-9998
Fax Number	:

Provider Business Practice Location Address
First Line	:	2358 E SOUTHCROSS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-2263
Country	:	US
Telephone Number	:	210-532-9998
Fax Number	:

Authorized Official
Title or Position	:	DENTIST PRESIDENT
Name	:	BEATRIZ CANTU PETTY
Credential	:	DDS
Telephone Number	:	210-532-9998

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	09/05/2007

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